Complete the Yellow Highlighted Areas and Submit Signed Letter on Company Letterhead

Complete the yellow highlighted areas and submit signed letter on company letterhead

NAME OF THE SUBMITTER

COMPANY NAME

COMPANY ADDRESS

COMPANY CONTACT INFORMATION

SUBMITTER’S EMAIL

DATE

Sarah Patterson

Chairman, Hydrostatic Stress Board

105 Decker Court, Suite 825

Irving, Texas 75062

RE: PPI TR-2 - Acquisition of Listings

Dear HSB Chairman,

COMPANY NAMEhas acquired certain assets/ products from COMPANY NAME (OF THE ACQUIRED)inMONTH/ YEAR. As such, COMPANY NAME is requesting to update the PPI HSB Listing Program to reflect this action by our company.

For all references to COMPANY NAME (OF THE ACQUIRED), update the systems to reflect the name ofCOMPANY NAME. This change pertains the following product listing(s).

INGREDIENT NAME1

-DESIGNATION (e.g., Paraffin Wax, Functional Equivalent Paraffin Wax; consult TR2 for list)

COMBINATION INGREDIENT PACKAGE NAME1

-Indicate the Ingredients in the package and the allowed use levels of each component in the package (in phr), reference PPI TR-2 Table I, Table 10 and the example for Table 10

FUNCTIONAL EQUIVALENT INGREDIENT PACKAGE NAME1

-Indicate the Ingredients in the package and the allowed use levels of each component in the package (in phr), reference PPI TR-2 Table I, Table 11 and the example for Table 11

COMPANY NAME confirms the source of supply for all required ingredients, manufacturing and processing equipment, and specified formulations for the compositions have not changed. [PRODUCT NAME1 and PRODUCT NAME2are still manufactured with the same specifications and ingredients as the originally listed formulation.] We understand and agree that this listing is given subject to the policies and procedures set forth in PPI TR-3.

COMPANY NAMEagrees to hold the Plastics Pipe Institute (PPI) harmless and indemnify PPI for any and all liability, loss, damage, cost and expense which PPI may suffer, incur, or be put to by reason of any claim, suit or proceeding for personal injury, property damage or economic loss on account of the failure or alleged failure of the compound listed (or pipe produced from the compound) to conform to specifications on which the listing is based, or based on the HDB, MRS, PDB or SDB assigned to the compound, and COMPANY NAMEfurther agrees to defend PPI at COMPANY NAME’s expense against any and all such claims, suits or proceedings.

Best Regards,

AUTHORIZED SIGNATURE

TITLE