Postgraduate Institute of Science – University of Peradeniya
Request for D8 Advanced Eco PXRD Analysis
Department/Institute/Industry: ………………………………………………………………………………....
Student Name: …………………………………...………..Reg No: …………………………………………
Programme (PGIS students only):………………………………………………………………………………
Supervisors Name:……………………………………………………………………………………………..
Sample Name (details) :
…………………………………………………………………………………………………..………………
…………………………………………………………………………………………………………………..
Please fill following table
User category
Undergraduate (University
of Peradeniya)
MSc/MPhil/PhD – PGIS
registered students
Other Universities/Research
Institutes/Other Government
Institute
Commercial sample
From
2Θ
To
Method
Diffractogram only
With analysis
Diffractogram only
With analysis
Diffractogram only
With analysis
Diffractogram only
With analysis
Cost per Number of Total amount
sample
Samples
(Rs)
(Rs)
750.00
1,250.00
750.00
1,250.00
1,500.00
3,000.00
3,000.00
6,000.00
Step size
Mode of Payment : ……………………………………… Receipt No: …………………………………..
(Please attach your payment slip)
I have declared that this sample does not contain any hazardous materials (biological/radioactive/explosive)
that cause hazardous during handling and analysis.
Student’s Sig: ……………………………………
For office use only
…………………………………………………….
Approval of the Director
Supervisor’s Sig: ………………………………….
………………………..
Date
Comment:
…………………………………………………………………………………………………………………
………………………………………………………………………………………………………………….
Operator’s Signature: ………………………..
Date: ……………………