Form Code LID-FORM-03.2 Page No.

Page 1 of 1
Revision No. 00
Reference No.
Effectivity Date 15 January 2024
Reservation and Release of Chemicals/Solutions/Reagents

Reminders: The requesting laboratory faculty shall write all the Chemicals/Solutions/Reagents needed in the experiment. We shall not
provide additional Chemicals/Solutions/mixtures on the day of the experiment. The reservation shall be done three (3) working days
prior to the conduct of the experiment. Please accomplish this form in triplicate (requesting laboratory faculty, LID office, and student).

To be accomplished by the requesting laboratory faculty:

Program: B S P s y c h o l o g y Grade/Year Level and Section/Block: 1 and 2

Subject/Course Code: CHEM 203.1 Subject/Course Description: ORGANIC CHEMISTRY
Title: Simple and Fractional Distillation Activity No.: 1

No. of Date Name of Signature of

Schedule Day/Time
Groups Needed Requesting Instructor Requesting Instructor
Monday-Tuesday/ 7:30-10:30 5 February 5-6, 2024
Monday-Tuesday/ 12:00-3:00 5 February 5-6, 2024 ANGELICA A. CABRIA

Form
Solution Volume/ Working Instructions Remarks
Chemical/Solutions/ Chemical
(to indicate the Weight (to be accomplished by (to be accomplished
Mixtures Name Formula
concentration
Concentrated needed Requesting Instructor) by LID staff)
of the solution)
Vodka 50 ml

*The requesting laboratory faculty shall receive feedback from LID staff on the availability of requested Chemicals/Solutions/Mixtures within 1 working day upon
submission in the lab unit.

To be accomplished by the LID staff:

Received by: Date:

(Signature over printed name)

Returned to: Date:

(Signature over printed name)

To be accomplished by the requesting Laboratory Faculty:

Released to: Date:

(Signature over printed name)