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R&D Application Form-FINAL

The document is an application form for gamma irradiation services from the Philippine Nuclear Research Institute. It requests information from applicants such as the name, institution, sample details, packaging, purpose of irradiation, schedule preference. It also includes sections for the irradiation facility staff to provide details on the approved irradiation schedule, facility used, dose delivered, time and cost. The form is used to collect essential information for R&D samples submitted for gamma irradiation.

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Jessie Ray Bacudo Mangundayao
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64 views

R&D Application Form-FINAL

The document is an application form for gamma irradiation services from the Philippine Nuclear Research Institute. It requests information from applicants such as the name, institution, sample details, packaging, purpose of irradiation, schedule preference. It also includes sections for the irradiation facility staff to provide details on the approved irradiation schedule, facility used, dose delivered, time and cost. The form is used to collect essential information for R&D samples submitted for gamma irradiation.

Uploaded by

Jessie Ray Bacudo Mangundayao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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NSD/ISS Form-002

Rev 0, 28-06-13
Republic of the Philippines
Department of Science and Technology
PHILIPPINE NUCLEAR RESEARCH INSTITUTE
Address: Commonwealth Avenue, Diliman, Quezon City
Telephone Nos. 929-6010 to 19 Fax No. 920-1646

APPLICATION FOR GAMMA IRRADIATION SERVICES


(For R & D use only)

NSD/ISS Request No.:

Name of Applicant :      


Institution/Company :      
Gov’t. Private Telephone No.:      
Address :       Cell phone No.:      
Address:       Fax No. :      
      Email :      

Name of Sample :      


Packaging Material :      
Purpose of Irradiation :      
Special Requirements :      
Preferred Schedule :      

Packaging Size
No. of Dose
Sample Label Length Width Height
Samples (kGy)
(cm) (cm) (cm)

                                   


                                   
                                   
                                   
                                   
                                   

Signature of Applicant : _______________________ Approved by: __________________________


Date : _______________________ LUVIMINA G. LANUZA
Head, Irradiation Services

====================================================================================================
Action Taken: (To be filled-up by Multipurpose Irradiation Facility personnel)

Approved Schedule of
Irradiation : Co-60 Facility : GC-220 PHI-5030
Date of Irradiation : Irradiation Lot No. :
Irradiation Position :
Total No. of Samples : Dosimeter (if any) :

Irradiation Time :
Total Irradiation Time (hrs) : Total Dose (kGy) :
Total Irradiation Cost (PHP) : Total Volume : m³ L

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