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["様式 K-9-4",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地下水","上澄み水","〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"D8&CHAR(13)&D9&CHAR(13)&D11&CHAR(13)&E12&CHAR(13) &D13&CHAR(13)&D14&CHAR(13)&D15&CHAR(13) &O15&CHAR(13)&O16&CHAR(13)&D17&CHAR(13)&D18& CHAR(13)&R18&CHAR(13)&D19&CHAR(13)&D20&CHAR(13)&D21&CHAR(13)&D22& CHAR(13)&J23&CHAR(13)&J24&CHAR(13)&D25&CHAR(13)&D26&CHAR(13)&D27&CHAR(13)&D28&CHAR(13)&D29&CHAR(13)&D30&CHAR(13)&D31","v":"\r\r\r-\r\r\r\r-    -\r-    -\r\r\r0\r\r\r\r\r\r\r\r\r\r\r\r\r"}]
[null,null,null,"試験依頼書(練混ぜ水の試験）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"工業用水","スラッジ水"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"井戸水","安定化スラッジ水"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"識別番号",null,"W",null,null,null,null,null,null,null,null,null,"湖沼水"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受 付 日",null,"令和","年 月 日",null,null,null,null,null,null,null,null,"河川水"]
["島根県生コンクリート工業組合共同試験場　　殿",null,null,null,null,null,null,null,null,null,null,null,null,null,"報告書受領日",null,"令和","年 月 日"]
[]
["顧　　客","ﾌﾘｶﾞﾅ"]
[null,"会社名"]
[]
[null,"ﾌﾘｶﾞﾅ"]
[null,"住　所",null,"(〒　　　","-",null,null,null,")"]
[]
[null,"ﾌﾘｶﾞﾅ",null,null,null,null,null,null,null,null,null,null,null,"連絡先"]
[null,"担当者名",null,null,null,null,null,null,null,null,null,null,null,"TEL","-    -"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX","-    -",null,null,null,null,null,null,"　　　　　　　"]
["報告書宛名",null,"会社名",null,null,null,null,null,null,null,null,null,null,null,null,null,null," 副本部数(有料)"]
[null,null,"住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,0,null,"  部"]
["請求書\n送付先",null,"会社名"]
[null,null,"住所"]
["採 取 年 月 日"]
["採  取  場  所"]
["水 の 種 類",null,null,"上水道水以外の水（",null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,"回収水　　　　　（",null,null,null,null,null,null,null,null,null,"）"]
["工    事    名"]
["試  験  項  目",null,null,null,null,null,"１. 懸濁物質の量",null,null,null,null,null,null,null,null,"（JIS A 5308：2026　附属書JC）"]
[null,null,null,null,null,null,"２. 溶解性蒸発残留物の量"]
[null,null,null,null,null,null,"３. 塩化物イオン（Cl-）量"]
[null,null,null,null,null,null,"４. セメント凝結時間の差"]
[null,null,null,null,null,null,"５.モルタルの圧縮強さの比(B法)"]
["備          考"]
[]
[]
["【共同試験場記入欄】"]
["試料の\n形状寸法、状態"]
[]
["試料持込年月日",null,null,"令和　　年　　月　　日",null,null,null,null,null,null,null,null,"□1.顧客による         □2.宅配便"]
["試料の処分方法",null,null,"　□当試験場で処分　・　　",null,null,null,null,null,null,null,"□引取（",null,null,null,null,null,")"]
["試験終了予定日",null,null,"令和　　年　　月　　日"]
["報告書発行予定日",null,null,"令和　　年　　月　　日"]
["試験場備考"]
[]
["注1；","依頼された試験について、その試験方法及び試験結果に関する質問及び苦情には責任を持ってお答えいたしますが、当試験場の責任外での結果の変更等についてはいかなる事情があろうとも応じることはできません。ただし、試験状況の監視の為の立会には、進んで協力いたします。"]
[]
[]
["注2；","当試験場は、試験等業務を遂行する上で知り得たお客様の業務上の情報を、他に漏らさないことをお約束いたします。ただし、以下の場合には当試験場の判断で第三者に開示することがございます。　\n①当試験場がISO/IEC17025等の審査を受ける際に登録及び認定機関に対し依頼書等を審査資料として開示する場合。\n②法令又は官公署からの命令･要請等があった場合。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"技術管理要員",null,"担当者"]
["　"]