NANO-SciTech Centre Level 3, Block C Tek 03 5544 4015/44 1 35 -S 40450 Shah Alam i ‘urulwahidasalam itn edu.my -VIS-NE rophot Selangor mohdazlané022ealam itm edu ay aE Ne Seema Applicant's Name __ Ait 94WitA_ 7 mg 6 Staff/Student No: _Se/6 ¥69935 ‘Supervisor's Name JR. 9440 Wao AVAL Email: shad a3" OA Hedi Telephone No. __oll= 29686709 Billing Address Programme Code: _ 48766 E-mail: nargyiofe 199 Qynail “Com Grant No. so0-1ent JERGD Sis Cag Rod PART B: SAMPLE INFORMATION Date Additional Info i _ Sample a 1D 1 | Wn eim cons 14a) CD Accessories Substrates Form 2 Min gl CPAMAL TS:H0,) ca). | Paralet [~] Glass [7] sola [3 [ie gin CPM tH ma) ca) 7 Ths Bim CP RRA Win JE DRA | Silicon [7] tiguia Thin Bt Create? eo) ¢f) = a : 2 reg 6TH RIM eater a) specha ae a TH BIN Cath ee) 62) g. THA RIN pA Thea) OD een Oy ‘We hereby certify that all information provided in this application are true. We also agree and understand that any damaged to the machine due to any falsification of this information will be our responsibility. Applicant's Signat Supervisor's Signature : OR. AHMAD az, (aPUSs Tate Es PART E: TERMS & CONDITIONS Application Status: [—) Approve Not Approve 1. Please submit the completed application form to NANO‘ entre 2 Please contact NANO-SciTech Centre pertaining to the Signature approval of the application, Please make sure that the workplace is in good condition before: you leave the laboratories, Date Completed: 4 Any damages or accidents must be reported immediately tothe authority officer Signature: 5, Maximum of 3 samples only are allowed foreach application. 8. Please use CD to copy you data from the computer. Any USB fortes ee oe drivers are not allowed to be used. UiTM:RM 15.00/Sample Non UiTM: RM 100.00 / SampleNANO-SciTech Centre Institute of Science Level 3, Block C Universiti Teknologi MARA 40450 Shah Alam Selangor -nueuleahida => Applicant's Name AU8 S9AA(RA 8 M29 1G Tole (8 5544 4415/4812 mall: salifsirusialam itn edu my ae |PL-RAMAN Supervisor's Name, 2h4AMAd HARB Ans ‘Staff/Student No; _ 2016969322 Email aimed nazibit Gppimng siti ectaring Telephone No: _#-27586 709 Billing Address Programme Code :_ASI°6 Email nurgsitha 19% Qh! Con Grant No.: coo tent FREE 5/3 € 68 (50/6) Date Measurement Excitation Additional Info i _ RAMAN 514.532nm nT Sample ar No. rm ‘TEMPERATURE DEPENDENT (TD) 1 | thin Gm CPPATS HQ) ed) 2 | rin Bin CAmma -TH 2%) Range/Temperature (TD) 3 [thn ein Chama T8900) a) to __ (within range 330 - 900) ¥ The Rm — canna THA) Oy to__ (within range 100 - 4000) Fotki RIN Coa TH) 7) S Thin BO cp Te) Cay —_t (able from -190°C to 300°C) S Thin Ri covaTe eer) Cg , i? & Thin Rim Crea Teed) — Cap ‘We hereby certify that all information provided in this application are true. We also agree and understand that any damaged to the machine due to any falsification of this information will be our responsibility. Applicant's Signaty Supervisor's Signature : T Nee T ONY Application Status: Approve Not Approve Signature: Date Completed Signature TOTAL CHARGE (RM) UiTM : RM 45.00/Sample OR. AHMAD NAZIB B. AL ZI B. ALIA s FARULT Sane Gunaan UTM CaMiaNaaN Pena KAMPUS TAA PART COONS Tess 1. Please submit the completed application form to NANO-SciTech Centre, 2. Please contact NANO-SciTech Centre pertaining to the approval of the application. 3, Please make sure that the workplace is in good condition before ‘you leave the laboratories 4. Any damages or accidents must be reported immediately to the authority officer. 5. Maximum of 3 samples only are allowed for each application. 6. Please use CD to copy you data from the computer. Any USB drivers are not allowed to be used. Non UiTM : RM 200.00 / SampleNANO-SciTech Centre Institute of Science Level, Block C Universiti Teknologi MARA 40450 Shah Alam Selangor Email sa => Applicant's Name; Hot Yq¥i24 €- nos Tet 083544 4215/0212 jussalam sitmadia my nurulwahida@ealam,itmaod my rmohdazlansl20zalam sited, een TGA Thermogravimetric Analyzer a ee | Supervisor's Name, OR A4™ADNABIE_AU AS Staff/Student No: 228/676 993" Email: abmauinai6 1 @ppinang “itm ecm Telephone No; _o" - 3986902 Billing Address : Programme Code: _ 8756 E-mail: aurea 14 Qgmnai len Grant No.: too. Ami 7PRGS_SB Og fou) Date Additional Info ] Form Sample oat No ae ieee iquid [1 [Pama = PvA soioton «) Za [2 [Pama ~ poe tation a | Ee) | Parameter 4. PMMA ~Pe DIGKIA wD Initial Temperature 30 To 00 __ (Degree Celcius) Rate °C (Degree Celcius/Minute) We hereby certify that all information provided in this application are true. We also agree and understand that any damaged to the machine due to any falsification of this information will be our responsibility. Applicant's Signature Application Status: Ld Approve Not Approve Signature: Date Completed Signature: ‘TOTAL CHARGE (RM) UST: RM 50.00 / Sample Supervisor's Signature : ‘OR. AHMAD NAZIEB, ALIAS ier FARUCTSANS Goivnan Um Canna pena Kaueus tara 1. Please submit the completed application form to NANO-SciTech Centre. 2, Please contact NANO-SciTech Centre pertaining to the approval of the application. 3, Please make sure that the workplace is in good condition before you leave the laboratories. 4. Any damages or accidents must be reported immediately to the authority officer 5. Maximum of 3 samples only are allowed for each application, 6, Please use CD to copy you data from the computer. Any USB rivers are not allowed to be used. Non UiTM: RM 150.00 / SamplePengarah, Institute of Science (IOS) Level 3, Block C, Universiti Teknologi MARA, 40450 Shah Alam, Selangor 3 OGOS 2018 Tuan, Memohon Kebenaran Bagi Pelajar untuk Menggunakan Makmal dan Peralatan di ‘Makmal Institute Of Science (IOS) Merujuk kepada perkara di atas, saya, Dr Ahmad Nazib bin Alias, ingin memohon kebenaran bagi pelajar di bawah seliaan saya, Nur Syahira binti Mujib ( 2016967725), untuk menggunakan Makmal dan Peralatan di Makmal Institute of Science (IOS). 2. Saudari Nur Syahira binti Mujib merupakan pelajar Sarjana Muda Sains Kimia di Fakulti Sains Gunaan yang memerlukan penggunaan alatan di makmal IOS untuk menjalankan eksperimen. Maklumat lanjut mengenai permohonan seperti berikut: Penyelia Dr Ahmad Nazib bin Alias Tempoh Penggunaan : 9 OGOS 2018- 24 OGOS 2018 Alatan Yang Diguna_: Fluorescence Spectroscopy 3. Untuk pengetahuan pihak tuan, pelajar saya akan berada dalam pengawasan pembantu di makmal [OS 4. Saya berharap agar permohonan saya ini dipertimbangkan dan seterusnya diluluskan oleh pihak Tuan, Segala perhatian dan kerjasama dari pihak Tuan amatla dihargai Sekian, Terima Kasih. Yang benar, ee __ (DR AHMAD NAZIB BIN ALIAS) Pensyarah, Fakulti Sains Gunaan Universiti Teknologi MARA Kampus Tapah