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[null,null,null,"所 在 地",null,null,null,null,null,null,"郵 便 番 号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電 話 番 号"]
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[null,null,"生活環境への配慮\n（ＩＳＯ１４００１等\nの認証を取得している\n場合は記入すること）"]
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[null,null,null,null,null,null,null,null,null,null,"その他製品の製造等に係る関係法令を遵守しています。"]
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[null,null,null,"購入単価等\n（原料が廃棄物\n以外の場合に記\n入すること）",null,null,null,null,null,null,"購 入 単 価",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"運　搬　者"]
[null,null,null,null,null,null,null,null,null,null,"購　入　先"]
[null,null,"エ","種類(名称)"]
[null,null,null,"発生場所"]
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[null,null,null,"利用見込量\n及び割合",null,null,null,null,null,null,"利用見込量",null,null,null," 年間 約",null,null,null,null,null,null,"トン",null,null,null,"製 品 中 の\n利 用 割 合",null,null,null," 全 原 料 中",null,null,null,"約",null,null,null,"％"]
[null,null,null,"購入単価等\n（原料が廃棄物\n以外の場合に記\n入すること）",null,null,null,null,null,null,"購 入 単 価",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"運　搬　者"]
[null,null,null,null,null,null,null,null,null,null,"購　入　先"]
[null,"そ\nの\n他\nの\n原\n料","種類及び利用割合"]
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[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,"製 品 中 の\n利 用 割 合",null,null,null," 全 原 料 中",null,null,null,"約",null,null,null,"％"]
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[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,"（その４）"]
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["６ 認 定 基 準 （ 該 当 す る 欄 に ○ を 付 す こ と ）","１ 安 全 性","有害物質",null,null,null,null,null,null,null,"(１)",null,"認定基準の適用"]
[null,null,null,null,null,null,null,null,null,null,"(２)",null,"適用除外（栃木県エコスラグ有効利用促進指針）"]
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[null,null,null,null,null,null,null,null,null,null,"理由及び\n基準名"]
[null,null,null,null,null,null,null,null,null,null,"(５)",null,"適用除外（循環資源の発生過程等から、環境汚染のおそれなし）"]
[null,null,null,null,null,null,null,null,null,null,"理由"]
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[null,null,null,null,null,null,null,null,null,null,"(２)",null,"適用除外（栃木県エコスラグ有効利用促進指針）"]
[null,null,null,null,null,null,null,null,null,null,"(３)",null,"適用除外（法律の規定による許可、登録、届出等）"]
[null,null,null,null,null,null,null,null,null,null,"法令名"]
[null,null,null,null,null,null,null,null,null,null,"(４)",null,"適用除外（他の基準の適用等が適当）"]
[null,null,null,null,null,null,null,null,null,null,"理由及び\n基準名"]
[null,null,null,null,null,null,null,null,null,null,"(５)",null,"適用除外（循環資源の発生過程等から、環境汚染のおそれなし）"]
[null,null,null,null,null,null,null,null,null,null,"理由"]
[null,"２ 品 質","舗装用材",null,null,null,null,null,null,null,"再生材の利用基準を満たしている（同基準に規格がないものは、栃木県土木工事共通仕様書による）"]
[null,null,"その他の製品",null,null,null,null,null,null,null,"(１)",null,"栃木県グリーン調達推進方針の判断基準を満たしている"]
[null,null,null,null,null,null,null,null,null,null,null,null,"栃木県グリーン調達推進方針に品目がない 又は 判断基準が示されていない"]
[null,null,"〔(1)、(2)のいずれにも記入すること〕",null,null,null,null,null,null,null,"(２)",null,"その他日本産業規格等の基準を満たしている"]
[null,null,null,null,null,null,null,null,null,null,"基準の名称\n及び内容"]
[null,"３ 利 用 割 合","舗装用材",null,null,null,null,null,null,null,"再生材の利用基準を満たしている"]
[null,null,"その他の製品",null,null,null,null,null,null,null,"(１)",null,"栃木県グリーン調達推進方針の判断基準を満たしている"]
[null,null,null,null,null,null,null,null,null,null,"(２)",null,"栃木県グリーン調達推進方針に品目がない 又は 判断基準が示されていない"]
[null,null,null,null,null,null,null,null,null,null,"その他の基準の名称\nと利用割合",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,"申請品の利用割合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"％"]
["【添付資料】",null,null,"※再度認定を受ける場合、4（法令に基づく許可証等のみ）、5、6及び7は、省略できる"]
[]
[null,"□"," 1 製品の説明書"]
[null,"□"," 2 製品の製造工程の説明書"]
[null,"□"," 3 製品の写真"]
[null,"□"," 4 認定基準等への適合を証明する書類（試験等結果書、法令に基づく許可証等）"]
[null,"□"," 5 製品のサンプル　※1 容易に持ち運べるよう適宜裁断すること、※2 舗装用材及びコンクリート二次製品を除く"]
[null,"□"," 6 会社の定款（写）及びパンフレット類"]
[null,"□"," 7 製造事業場の位置図"]
[null,"□"," 8 認定証の写し　※既に認定を受けている場合に限る"]
[null,"□"," 9 県税事務所長発行の納税証明書(未納がない旨の証明・県提出用) ※栃木県に納税義務を有する場合に限る"]
[null,"□","10 その他審査に必要となる資料　※必要に応じて添付"]