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• A • <br /> %,w I/ Dispenser Conversion Evaluation • <br /> DISTRIBUTOR: P.O.#: <br /> SALESPERSON: DATE: <br /> Yes No <br /> I7Bravo UDC? 1-1 OR <br /> IF NOT A BRAVO UDC <br /> MAKE/MODEL# <br /> SHALLOW PAN [:] DEEP SUMP QUANTITY <br /> NUMBER OF EXISTING ANCHOR BOLTS FOR CONCRETE PAD/ISLAND:❑ <br /> Yes No <br /> DOES THE EXISTING UDC HAVE A WATER SPLASH LIP? ❑ ❑ <br /> WATER ' + • ' DISPENSEqp <br /> RMEASURMENT SHOULD BE PLUS/MINUS 1/4" NEW <br /> E DISPENSER <br /> Q LENGTH: + / - 1 /411 MANUFACTURER: <br /> U INCHES <br /> DISPENSER <br /> MODEL#: <br /> E WIDTH: + / - 1 /4 <br /> INCHES <br /> FOR THE STATE OF CALIFORNIA - PURCHASE OF ADDITIONAL COMPONENTS MAY BE REQUIRED <br /> F-1 1-1 (IF YES: Retrofit plates required in <br /> Does conduit exist within 2" of the inner opening? California.Retrofit plates recommended <br /> Yes No Outside of California.) <br /> Does conduit exist outside the UDC water splash lip?1-1 1-1 IF YES CHECK BOX 2 BELOW_ <br /> Is conduit on 1 or 2 ❑ 1 SIDE ❑ <br /> SIDES A <br /> 2 ND WIDE FRAME DISPENSERS <br /> sides of vapor panel? <br /> CHECK BOX 2 SIDE NARROW FRAME DISPENSER STANDARD CONVERSION-FRAME WILL NOT WORK.....CONTACT FACTORY <br /> BRAVO USE ONLY1 SALES ORDER# FOR ASSISTANCE, CALL 800-AT-BRAVO <br /> FAX TO 323-888-4123 OR EMAIL TO <br /> EXISTING# NEW# YOUR SALES REPRESENTATIVE <br />