For Tr-2/Tr-4: Ppi Pvc Generic Range Formulation

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, Ste. 825

Irving, TX 75062

RE: PPI TR4 - PPI PVC Generic Range Composition Dependent Listing Request

Dear HSB Chairman,

We wish to list with the Plastics Pipe Institute Hydrostatic Stress Board (PPI HSB), under our commercial designation compound name, the pre-qualified PVC range compound as defined in PPI TR-2. We would also like to have this listing published in PPI TR-4. We understand and agree that this listing is given subject to the policies and procedures set forth in PPI TR-2 and TR-3.

We understand that this PVC compound is pre-qualified for a 4,000 psi Hydrostatic Design Basis (HDB), and a maximum Hydrostatic Design Stress (HDS) of 2,000 psi 73oF (23oC) for sustained water pressure, provided that only the specified materials are used, the blend of these materials is suitably homogenized prior to extrusion, and the extrusion into pipe is so conducted as to satisfy all the requirements of the applicable and current recognized product standard(s).

We understand PPI TR-3 and PPI TR-2 requirements will be followed to include the following:

Only ingredients specified for the PPI PVC Range Composition at the stipulated allowable levels (PPI TR-2 Table 1) will be used in the production of this compound. Ingredients are listed in

‒PPI TR-2 Part A.2 – A.6: PreQualified Ingredients (not required to list in PPI TR-2). Any ingredient not complying to the predefined properties in PPI TR-2 Part A.2 – A.6 is categorized as a Functional Equivalent Ingredient.

‒PPI TR-2 Tables 10 – 11: Combination Packages and Functional Equivalent Ingredient Packages, respectively. (All packages are required to list).

If a Functional Equivalent Ingredient is used, only a maximum of one will be present in the formulation. Two or more are not allowed at this time.
If a Liquid Dispersed Colorant is used, only a maximum of one will be present in the formulation. Two or more are not allowed at this time.

The requestor confirms they received from the Independent Listing Owner, the appropriate source detailing the requirements.

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,

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