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["시 험 · 검 사 의 뢰 서",{"$nulls":9},"접 수"]
[{"$nulls":10},"번 호"]
["의\n뢰\n업\n체\n-\n계\n산\n서","상호(명칭)",{"$nulls":12},"사업자등록번호(업태/종목)"]
[]
[null,"성명(대표자)",{"$nulls":12},"성명(실무자)"]
[null,"사업장주소 :",{"$nulls":12},"메일주소(E-mail)"]
[{"$nulls":18},"@"]
[null,"전 화",null,"(        )",null,null,"팩 스",null,"(        )",{"$nulls":5},"휴대폰",null,null,"(        )"]
[null,"성적서 수령방법",null,null,"                                                  (                                                         )"]
[null,"[개인정보활용동의] 본인은 다음의 목적(시료 접수/검사), 범위(국세청-부가세신고 및 각 지방자치단체-시험성적서 결과 통보 등)\n                          보존기간(관련법에 의한 3년보존)에 따라 개인정보활용에 동의 합니다."]
["시\n\n료\n\n정\n\n보","채수지 주소 : ",{"$nulls":17},"의뢰인(신고인명)"]
[]
[null,"시험구분",{"$nulls":4},"시료구분",{"$nulls":8},"신고번호",null,null,null,"제               호"]
[null,"채 수 방 법"]
[null,"봉인/입회자",null,null,"소속:",{"$nulls":4},"직급:",{"$nulls":6},"성명:"]
[null,"채 수 량",null,null,"멸균채수병           L       개 /   150 mL         개 /  50 mL          개 / 유리병         개"]
[null,"의뢰근거",null,null,"검사목적",null,"사용용도",{"$nulls":6},"검사항목수",{"$nulls":4},"검사항목(재검/일부항)"]
[{"$nulls":13},"46 / (    )개 항목"]
[{"$nulls":13},"20 / (    )개 항목"]
[{"$nulls":13},"15 / (    )개 항목"]
[{"$nulls":13},"15 / (    )개 항목"]
[{"$nulls":13},"48 / (    )개 항목"]
[{"$nulls":13},"52 / (    )개 항목"]
[{"$nulls":13},"47 / (    )개 항목"]
[{"$nulls":13},"(    )개 항목"]
[{"$nulls":13},"13 / (    )개 항목"]
[{"$nulls":13},"4 / (    )개 항목"]
[{"$nulls":13},"6 / (    )개 항목"]
[{"$nulls":13},"7 / (    )개 항목"]
[{"$nulls":13},"10 / (    )개 항목"]
[{"$nulls":13},"58 / (    )개 항목"]
[{"$nulls":13},"59 / (    )개 항목"]
[{"$nulls":13},"2 / (    )개 항목"]
[{"$nulls":13},"12개 항목"]
[{"$nulls":13},"6개 항목"]
[{"$nulls":13},"(   )개 항목"]
[]
[{"$nulls":13},"(   )개 항목"]
["참 고","첨부서류",{"$nulls":11},"이중시료"]
["사 항"]
["    『수질검사업무규정』 제4조 제1항의 규정에 의하여 시험을 의뢰합니다."]
["접수/채수일 : 20     년       월        일"]
["접수자 :                       (서명/인)                                     신청인(개인정보동의 포함) :                   (서명/인)"]
["(예금주 :              )",{"$nulls":11}," 세금계산서 : "]
["1. 검사수수료를 납부하지 않은 경우에는 검사를 진행하지 않습니다.(입금예정일:     년     월     일 )\n2. 입금계좌: 국민은행 676901-01-170867 예금주: KOTITI시험연구원"]
["KOTITI 시험연구원 귀하",{"$nulls":10},"수수료\n(부가세포함)",{"$nulls":8},"원"]
["OPWF-08-01"]