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[]
[" 様式 2-2"]
["　小田原鉱石株式会社　"]
["　アスベスト 建材分析依頼書　"]
[" ■枠内の事項を記入し E-mail でお送りください。　　※は必ず記入をお願いします。"]
["　　　フ　リ　ガ　ナ"," 会社名/所属等",null,"ご担当者様　"]
[" ご依頼者様（※）\n"]
[null,"〒"]
[null,"TEL：",null,"FAX："]
[null,"E-mail："]
["　　　フ　リ　ガ　ナ"," 会社名/所属等",null,"ご担当者様"]
[" 報告書送付先（※）\n\n"]
[null,"〒"]
[null,"TEL：",null,"FAX："]
[null,"E-mail："]
[" 報告書部数（※）","部"]
[" 残試料の扱い",null,null,null,"※チェックが無い場合、弊社にて適正廃棄致します。  "]
[" 弊社への到着予定日"]
[]
[" 報告書宛名（※）　"]
[" 件名（※）　"]
[" 採取場所住所"]
[" 試料No.",1,2,3,4]
[" 採取年月日"]
[" 試料名称（※）　"]
[" 建物、配管設備、機器等"]
[" の名称及び用途"]
[" 施工年及び建築物への\n 施工などを採用した年"]
[" 建物などの採取部位\n 及び場所"]
[" 形状又は材質"]
[" 試料の大きさ"]
[" 採取者所属・氏名"]
[" 特記事項"]
[" ご要望"]
["【 依頼書送付先 】　こちらまでお願いします。\nE-mail: odako.rep@odawarakoseki.co.jp",null,null,"〒256-0815 神奈川県小田原市小八幡2-3-6 2階\nTel : (0465)-33-6612\nHP : http://www.odawarakoseki.co.jp"]
[null,null,"　　　　　小田原鉱石株式会社　分析依頼書　【多検体用】"]
[" 試料No.",{"$f":"E23+1","v":5},{"$f":"B37+1","v":6},{"$f":"C37+1","v":7},{"$f":"D37+1","v":8}]
[" 採取年月日"]
["試料名称（※）"]
[" 建物、配管設備、機器等"]
[" の名称及び用途"]
[" 施工年及び建築物への\n 施工などを採用した年"]
[" 建物などの採取部位\n 及び場所"]
[" 形状又は材質"]
[" 試料の大きさ"]
[" 採取者所属・氏名"]
[" 特記事項"]
[]
[]
[" 試料No.",{"$f":"E37+1","v":9},{"$f":"B50+1","v":10},{"$f":"C50+1","v":11},{"$f":"D50+1","v":12}]
[" 採取年月日"]
[" 試料名称（※）"]
[" 建物、配管設備、機器等"]
[" の名称及び用途"]
[" 施工年及び建築物への\n 施工などを採用した年"]
[" 建物などの採取部位\n 及び場所"]
[" 形状又は材質"]
[" 試料の大きさ"]
[" 採取者所属・氏名"]
[" 特記事項"]
[]
[]
[null,null,"　　　　　小田原鉱石株式会社　分析依頼書　【多検体用】"]
[" 試料No.",{"$f":"E50+1","v":13},{"$f":"B64+1","v":14},{"$f":"C64+1","v":15},{"$f":"D64+1","v":16}]
[" 採取年月日"]
["試料名称（※）"]
[" 建物、配管設備、機器等"]
[" の名称及び用途"]
[" 施工年及び建築物への\n 施工などを採用した年"]
[" 建物などの採取部位\n 及び場所"]
[" 形状又は材質"]
[" 試料の大きさ"]
[" 採取者所属・氏名"]
[" 特記事項"]
[]
[]
[" 試料No.",{"$f":"E64+1","v":17},{"$f":"B77+1","v":18},{"$f":"C77+1","v":19},{"$f":"D77+1","v":20}]
[" 採取年月日"]
[" 試料名称（※）"]
[" 建物、配管設備、機器等"]
[" の名称及び用途"]
[" 施工年及び建築物への\n 施工などを採用した年"]
[" 建物などの採取部位\n 及び場所"]
[" 形状又は材質"]
[" 試料の大きさ"]
[" 採取者所属・氏名"]
[" 特記事項"]

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[]
[null,"　小田原鉱石株式会社　"]
[null,"　アスベスト 建材分析依頼書　"]
[null," ■枠内の事項を記入し E-mail でお送りください。　　※は必ず記入をお願いします。"]
[null,"　　　フ　リ　ガ　ナ"," 会社名/所属等　　△△ｶﾌﾞｼｷｶﾞｲｼｬ",null,"ご担当者様　　　　　オダワラ　タロウ"]
[null," ご依頼者様（※）\n"," △△株式会社　□□部",null," 小田原　太郎"]
[null,null," 〒○○○○-○○\n 神奈川県小田原市△△町○-○　××ビル３F"]
[null,null,"TEL：0465-○○-○○○○",null,"FAX：0465-○○-○○○○"]
[null,null,"E-mail：odawara@○○○.co.jp"]
[null,"　　　フ　リ　ガ　ナ"," 会社名/所属等",null,"ご担当者様"]
[null," 報告書送付先（※）\n\n"]
[null,null,"〒\n"]
[null,null,"TEL：",null,"FAX："]
[null,null,"E-mail："]
[null," 報告書部数（※）","３　部"]
[null," 残試料の扱い",null,null,null,"※チェックが無い場合、弊社にて適正廃棄致します。  "]
[null," 弊社への到着予定日","○月〇日"]
[]
[null," 報告書宛名（※）　","　○○株式会社"]
[null," 件名（※）　","　○×ビル解体工事　アスベスト調査"]
[null," 採取場所住所"]
[null," 試料No.",1,2,3,4]
[null," 採取年月日","2022-05-01","同左","2022-05-02"]
[null," 試料名称（※）　","機械室　天井\n吹付け材","機械室　配管エルボ\n保温材","電気室　壁\nケイカル板"]
[null," 建物、配管設備、機器等","○○ビル3階","同左","○○ビル地下1階"]
[null," の名称及び用途","吹付け材","配管エルボ","耐火材"]
[null," 施工年及び建築物への\n 施工などを採用した年","1970-02-01","同左","-"]
[null," 建物などの採取部位\n 及び場所","機械室　天井","機械室　配管エルボ","電気室　壁"]
[null," 形状又は材質","ウール状","粉状","板状"]
[null," 試料の大きさ","3×3×2cm×3個所","－","5×5×1cm"]
[null," 採取者所属・氏名","△△㈱　小田原太郎","同左","-"]
[null," 特記事項"]
[null," ご要望"]
[null,"【 依頼書送付先 】　こちらまでお願いします。\nE-mail: odako.rep@odawarakoseki.co.jp",null,null,"\n\n〒256-0815 神奈川県小田原市小八幡2-3-6 2階\nTel : (0465)-33-6612\nHP : http://www.odawarakoseki.co.jp"]
[null,null,null,"　　　　　小田原鉱石株式会社　分析依頼書　【多検体用】"]
[null," 試料No.",5,6,7,8]
[null," 採取年月日"]
[null," 試料名称（※）"]
[null," 建物、配管設備、機器等"]
[null," の名称及び用途"]
[null," 施工年及び建築物への\n 施工などを採用した年"]
[null," 建物などの採取部位\n 及び場所"]
[null," 形状又は材質"]
[null," 試料の大きさ"]
[null," 採取者所属・氏名"]
[null," 特記事項"]
[]
[]
[null," 試料No.",9,10,11,12]
[null," 採取年月日"]
[null," 試料名称（※）"]
[null," 建物、配管設備、機器等"]
[null," の名称及び用途"]
[null," 施工年及び建築物への\n 施工などを採用した年"]
[null," 建物などの採取部位\n 及び場所"]
[null," 形状又は材質"]
[null," 試料の大きさ"]
[null," 採取者所属・氏名"]
[null," 特記事項"]