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,3212 N. <br /> ✓TOGLUNI��' <br /> Dispenser Conversion Evaluation Form <br /> Distributor: Sales Person: P.O. # <br /> Existing Dispenser <br /> MANUFACTURER Gtil�►a�.c <br /> SPECIFIC MODEL NUMBER a�8 <br /> NEW Dispenser <br /> MANUFACTURER Wp-V►f. <br /> SPECIFIC MODEL NUMBER 0v&,rioN t3 <br /> Existing UDC Sump DISPENSER/HYDRAULIC CABINET <br /> Is it a Bravo UDC? ❑ or Make/Model <br /> Shallow pan or Deep Sump? <br /> h II i WATER SPLA,SI <br /> Water splash lip opening (I.D.): Length L� Width <br /> 1 <br /> #of existing Anchor Bolts for concrete pad/island: 4 <br /> Does the existing UDC have a water splash lip? 4Es <br /> FOR THE SME OF CALIFORNIA - PURCHASE OF ADDITIONAL COMPONENTS WIN tE REQUIRED <br /> Does conduit exist within 2" of the inner opening? qEt,. ( IF YES, IMAGES ARE REQUIRED) <br /> 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 /> '!) <br /> BRWO WWW.SBRAVO.COM dw. <br /> made Ali iedPROBL.EMBOLVED 800-AT-BRAVOin USA I',B�meuE^rie ( fl <br />