Serial No:

TESTING REQUISITION FORM

Scanning Electron Microscope (SEM)
**SAMPLE TYPE: SOLID & POWDER
**AMOUNT OF SAMPLE: Minimal
**SIZE : 3x3x3 cm/as discussed
( ) Hi Vacum ( ) Spot area
( ) Low vacum ( ) Elemantal mapping
( ) ESEM ( ) Line scanning
Magnification (100x-200x)
a)
b)
c)
Others:________________________ Others:________________________
Types/Condition of samples
Dry ( ) Moist/wet ( ) Thin film/ ( ) Beam ( ) Toxic ( )
coating sensitive
Others:________________________
For Official Use Only
APPROVED BY: SUBMITTED BY
Initial:________________ Date:________
SUBMITTED TO
DATE :___________ Initial:________________ Date:________
SUBMITTED TO
Lab copy T.S copy
Analyst:________________ Date:________
EDX METHODS
TOTAL=
EDX
Prefer (Optional) Parameter:
SEM METHODS
SEM
ANALYSIS REQUIRED SAMPLE DESCRIPTIONS SAMPLE ID
REQUESTED BY DATE OF SUBMITTION
ADDRESS DUE DATE
ASSIGNMENT UNIT
INITIAL REF. NO.
REF. NO.
SCIENCE OFFICER