Request for sample analysis with 3FLEX Date: ____/______/________

Analysis type: __________________________________________________________________________

Student Name: __________________________________________ Entry No. _______________________

Department and mailing address: ____________________________________________________________

_______________________________________________________________________________________

E-mail ID: ___________________________________ Contact No. ________________________________

Advisor/ PI: ____________________________________________________________________________

Sample identifier: _____________________ Sample type: Microporous/ mesoporous/ other_____________

Quantity of sample provided (g) ________________ Estimated composition: ________________________

Degassing scheme: _______________________________________________________________________

_______________________________________________________________________________________

Analysis scheme: ________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Signature of advisor Signature of the lab-incharge Sample received by:

Prof. Divesh Bhatia, Date: ______________________

Dept. of Chemical Engineering Time: _____________________