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� 1Dispenser Conversion Evaluation Form� <br /> n <br /> Distributor.; Sales Persona: P.OExisting Dispenser .A. <br /> II <br /> FUFACTURER 6�,�6:2 <br /> SPECIFIC MODEL NUMBERNEW Dispenser <br /> l ; <br /> MANUFACTURER <br /> SPECIFIC MODEL €U-M E R_ d' <br /> ing <br /> DISPENSER!HYDRAULIC CABINET <br /> ExistUDC Sump <br /> 1 7 <br /> Is in a Bravo IJDC? ❑ or Make/Model <br /> Shallow pan or Deep Sump? e- q- <br /> 3 - <br /> Water splash lip opening(LD.): Length Width t t sp�nst u� <br /> #of existing Anchor Bolls for concrete pad 1 island: <br /> Does the existirig UDe have a water splash lip? <br /> IMM19 AMLIFSBMW <br /> Does conduit exist within 2"of the inner opening? Al 10 (IF YES,IMAGES ARE REQUIRED) <br /> 12, Does conduit exist outside of the UDC water splash lip? (IF YES,IMAGES.ARE REQVIRED) <br /> FOR ASSISTANCE, CALL 800-AT-BRAVO <br /> BRAVO <br /> FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br /> 12A <br /> - <br /> BRkV0 .SBRAVG.COM ); d <br /> g�p� pyo �/ ��.. •- <br /> R€IMEMSMOULV60 800 Al Y �I�.USA 1' '9t�tvs an T=s 't3'EM,B;fiR V <br />