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R <br />E <br />Q <br />U <br />I <br />R <br />E <br />D <br />DISTRIBUTOR: <br />P.O.#: <br />SALESPERSON: <br />DATE: <br />Yes No <br />Is it a Bravo UDC? OR <br />IF NOT A BRAVO UDC <br />MAKE/MODEL# <br />ISHALLOW PAN F—] DEEP SUMP F—] QUANTITY <br />NUMBER OF EXISTING ANCHOR BOLTS FOR CONCRETE PAD/ISLAND: 1-1 <br />Yes No <br />-DOES THE EXISTING UDC HAVE A WATER SPLASH LIP? ❑ ❑ <br />LENGTH:INCHES + / - 1/4// <br />WIDTH: + / - 1/4 it <br />DISPENSER <br />MANUFACTURER: <br />DISPENSER <br />MODEL #: _ <br />INLHlh:b I <br />FOR THE STATE OF CALIFORNIA - PURCHASE OF ADDITIONAL COMPONENTS MAY BE REQUIRED <br />Does conduit exist within 2" of the inner opening?F-1 ❑ (IF YES: Retrofit plates required in <br />California. Retrofit plates recommended <br />Yes No outside of California.) <br />Does conduit exist outside the UDC water splash lip? F] 1-1 IF YES, CHECK BOX 2 BELOW <br />Is conduit on 1 or 2 IJ 1 SIDE <br />sides of vapor panel? <br />CHECK BOX 2 SIDE <br />NARROW FRAME DISPENSER STAN <br />BRAVO USE ONLY1 SALES ORDER# <br />EXISTING # <br />NEW # <br />2 SIDES AND WIDE FRAME DISPENSERS <br />W CONVERSION FRAME WILL NOT WORK..... CONTACT FACTORY <br />FOR ASSISTANCE, CALL 800 -AT -BRAVO <br />FAX TO 323-888-4123 OR EMAIL TO <br />YOUR SALES REPRESENTATIVE <br />