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Nov 1814 09:32a APEC/BRC 209 943 3003 1 <br />& <br />Dispenser Conversior <br />Distributor: Sales Person: <br />I' OV 18 2014 <br />EvaluattowForm.. <br />man <br />Lxistiono. Dis,enser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />NEW Dispenser <br />MANUFACTURER <br />SPECIFIC MODEL NUMBER <br />rr=xistin,ma UDC ump <br />S <br />DISPENSER I HYDRAULIC CABINET <br />LENGTH <br />Is it a Bravo UDC*? 13 or Make/Model X.' <br />L <br />Shallow pan or Deep Sump? <br />Water splash lip opening (I.D.): Length Width <br />WATER SPLASH LIP <br />LIP <br />of existing Anchor Bolts for concrete pad I island: <br />Does the existing UDC have a water splash lip? <br />FOR THE SIATE Of- CALIFORNIP1 - POINGRA95 OF OQUITIONAL COMPONENTS WN BE ROUND <br />Does conduit exist within 2- of the Inner opening? IF YES, IMAGES ARE REQUIRED <br />(IF YES, IMAGES ARE REQUIRED) <br />1121 Does conduit exist outside of the UDC water splash lip? <br />14A <br />made Cerfifiej <br />in U 00 <br />SA [-VffiRC] CA`- P. <br />