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Dispenser Conversion Evaluation Form <br />Distributor: Sales Person: P.O. # <br />Existing Dispenser <br />MANUFACTURER Gi I L,%a t -.G0 <br />SPECIFIC MODEL NUMBERGv- <br />NEW Dispenser <br />MANUFACTURER C� 1 k.-Rtarrtc <br />SPECIFIC MODEL NUMBER -700—S (—,T4-01 <br />Existing UDC <br />Sump DISPENSER / HYDRAULIC CABINET <br />Is it a Bravo UDC? / or Make/Model <br />Shallow pan or Deep Sump? 'SWrt,"O p <br />3�11'4&"Widtlr2Y"l3Vy WATEt2 SP <br />Water splash lip opening (LD.): Length <br /># of existing Anchor Bolts for concrete pad / island: 4' <br />Does the existing UDC have a water splash lip? Nb <br />1 <br />THE FOLLOWING APPLIES TO THE STATE OF CALIFORNIA ONLY <br />Does conduit exist within 2" of the inner opening? Nd (IF YES, IMAGES ARE REQUIRED) <br />2 Does conduit exist outside of the UDC water splash lip? N'O (IF YES, IMAGES ARE REQUIRED) <br />'---' <br />FOR ASSISTANCE, CALL 800 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br />12A <br />hBNVO WWW.SBRAVO.COM made Cerci ted <br />_l O=`��SOL $00 -AT -BRAVO; .� in USA a14--fr � MEMBER <br />