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A quick learner from Wapakoneta ohio says:
30D BSI ET
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Lauren from SWISCO responded:

Hello, thank you for posting,

Your balance resembles the Series 795 channel balance, but with the 15-198 hook for install instead of a screw clip. This configuration will require a custom order for you to assemble.

Dimensions for 15-195
Dimensions for 15-195

To further review, please confirm that the width of the T-lock shoe is 1-1/4" wide and has a closed metal cam style (not see through). Also please provide the quantity needed. For custom orders, there is a minimum order of (2). 

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