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BRAVO <br /> Cw_�) Dispense r Cc live rs lon Fvaluation Form <br /> DISTRIBUTOR: P.O.#: <br /> SALESPERSON: DATE: <br /> Yes No <br /> Is it a Bravo UDC? ❑OR <br /> IF NOT A BRAVO UDC <br /> MAKE/MODEL# <br /> SHALLOW PAN D DEEP SUMP [:] QUANTITY <br /> r _ r <br /> NUMBER OF EXISTING ANCHOR BOLTS FOR CONCRETE PAD/ISLAND: <br /> Yes No <br /> "DOES THE EXISTING UDC HAVE A WATER SPLASH LIP?l.__l FI <br /> sg # < • <br /> DISPENSER <br /> LENGTH: INCHES MANUFACTURER: <br /> DISPENSER <br /> MODEL#: <br /> WIDTH: + /- 1/4° <br /> INCHES <br /> " 3 1 HE S i,ATE OF CALIFORNIA- PURCHASE OF ADDITIONAL COMPONENTS MAY BE REQUIRED <br /> Does conduit exist within 2"of the inner opening? YES:Retrofit plates required in <br /> � F-1CCaalifornia.Retrofit plates recommended <br /> Yes No outside of California.) <br /> Does conduit exist outside the UDC water splash lip?❑ ® IF YES,CHECK BOX 2 BELOW <br /> Is conduit on 1 or 2 1 SIDE [:]sides of vapor panel? 2 SIDES AND WIDE FRAME DISPENSERS <br /> CHECK BOX 2 SIDE STAN F R <br /> NARROW FRAME DISPENSER <br /> BD" SDN ' SALES ORDER# FOR ASSISTANCE, CALL 800-AT-BRAVO <br /> FAX TO 323-888-4123 OR EMAIL TO <br /> EXISTING# NEW# YOUR SALES REPRESENTATIVE <br />