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Dispenser <br /> e Evaluation <br /> istributor: Sales Person: P.O. # <br /> Existing Dispenser <br /> MANUFACTURER <br /> SPECIFIC L NUMBERL MANUFACTURER UjAIAI—e9 <br /> 1-—� <br /> NEW Dispenser <br /> CC MO <br /> SPECC MODEL NUMBER <br /> IFI <br /> Existing UDC SUMP DDSIf��IsleR r Ii Y DRAUl.Ic C� I <br /> 1 I' <br /> Is it a Bravo LDDC? ❑ or Make/Model111 <br /> S <br /> Shallow pan or Deep Sump? _ q <br /> Water splash lip opening(I.D.): Length Width sH i i� <br /> #of existing Anchor Bolts for concrete pad 1 island: _ ry <br /> Does the existing UDC have a water splash lip? <br /> baa <br /> ! I Does conduit exist within 2"of the inner opening? Aiz (IF YES,IMAGES ARE REQUIRED) <br /> c-..a <br /> 12: Does conduit exist outside of the UDC water splash lip? {IF YES,1 AGES ARE REQUIRED') <br /> FOR ASSISTANCE, C-ALL800-AT-BRAVO <br /> FAX TO 323-888-4123 OR EMAIL TO YOUR SALES REPRESENTATIVE <br /> 12A <br /> BRkVOSB VQ.C4 c, r 1 p e <br /> ON= <br /> SLva <br /> Irl .r ssF� r :sR <br />