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Dispenser Conversion Evaluation Form <br /> Distributor: Sales Person: P.O. # <br /> Existing Dispenser <br /> MANUFACTURER <br /> SPECIFIC MODEL NUMBER <br /> NEW Dispenser <br /> MANUFACTURER <br /> SPECIFIC MODEL NUMBER <br /> Existing Sump UDC DISPENSER / HYDRAULIC CABINET <br /> LENGTH <br /> Is it a Bravo UDC? ❑ or Make/Model <br /> X <br /> Shallow pan or Deep Sump? o <br /> Water splash lip opening (I.D.): Length Width WATER SPLASH LIP <br /> #of existing Anchor Bolts for concrete pad / island: <br /> Does the existing UDC have a water splash lip? <br /> FOR THE STATE OF CALIFORNIA - PURCHASE OF ADDITIONAL COMPONENTS MAY BE REQUIRED <br /> =- <br /> ADoes conduit exist within 2" of the inner opening? ( IF YES, IMAGES ARE REQUIRED ) <br /> 12; Does conduit exist outside of the UDC water splash lip? ( IF YES, IMAGES ARE REQUIRED ) <br /> FOR ASSISTANCE, CALL 800-AT-BRAVO <br /> FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br /> 14A <br /> BRkVO WWW SBRAVO.COM _ made Certified <br /> B NC � � <br /> 800-AT-BRAVO In USA ix „,��u,,,�s,e„.�r�u EM <br /> PROBLEM SOLVED - <br />