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["様式 K-9-3",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,"砕砂","砕石","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)&D23&CHAR(13)&D24&CHAR(13)&G25&CHAR(13)&R25&CHAR(13)&G26&CHAR(13)&R26&CHAR(13)&D27&CHAR(13)&O27&CHAR(13)&D28&CHAR(13)&D29&CHAR(13)&D30&CHAR(13)&D31&CHAR(13)&D32&CHAR(13)&D33&CHAR(13)&D34&CHAR(13)&D35","v":"\r\r\r-\r\r\r\r-    -\r-    -\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r\r"}]
[null,null,null,"試験依頼書(骨材試験）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"川砂","川砂利"]
[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,"山砂"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"識別番号",null,"B",null,null,null,null,null,null,null,null,null,"陸砂"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受 付 日",null,"令和","年 月 日"]
["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 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,"印","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,null,null,"  部"]
["請求書\n送付先",null,"会社名"]
[null,null,"住所"]
["産　　　　　地"]
["採 取 年 月 日"]
["採  取  場  所"]
["試 験 希 望 日"]
["骨 材 の 種 類",null,null,"細骨材（",null,null,null,null,null,"）",null,null,null,null,null,"　その他（",null,null,null,"）"]
[null,null,null,"粗骨材（",null,null,null,null,null,"）",null,null,null,null,null,"　その他（",null,null,null,"）"]
["大　  き  　さ",null,null,null,null,null,null,null,null,null,"㎜","製品の名称："]
["工    事    名"]
["試  験  項  目",null,null,null,null,null,"１．細骨材有機不純物試験（JIS A 1105：2015）"]
[null,null,null,null,null,null,"２．骨材の塩化物量試験（JIS A 5308：2019 附属書A A.10 p)）"]
[null,null,null,null,null,null,"３．骨材のふるい分け試験（JIS A 1102：2014）"]
[null,null,null,null,null,null,"４．硫酸ナトリウムによる骨材の安定性試験（JIS A 1122：2014）　"]
[null,null,null,null,null,null,"５．ロサンゼルス試験機によるすりへり試験（JIS A 1121：2007）"]
[null,null,null,null,null,null,"６．骨材の微粒分量試験（JIS A 1103：2014）"]
["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"]
[]
["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"]
["　"]