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[null,null,"　建設住宅性能評価の申請を行うにあたり、施工状況報告書を提出します。施工状況報告書に記載する内容は、事実に相違ありません。"]
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[null,null,"建築物の名称　※"]
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[null,null,"建築物の所在地　※"]
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[null,null,null,"※","検査毎に第１面と該当する部分を記入の上、提出して下さい。"]

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[null,"性能表示","測　定　記　録　欄"]
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["空気環境に関する事","特定測定","採取開始日時・天候",{"$nulls":5},"年",null,null,"月",null,null,"日",{"$nulls":4},"時",null,null,"分",null,"天候（",{"$nulls":9},"）"]
[null,"物質の濃","採取終了日時・天候",{"$nulls":5},"年",null,null,"月",null,null,"日",{"$nulls":4},"時",null,null,"分",null,"天候（",{"$nulls":9},"）"]
[null,"度等","採取した居室の名称"]
[null,null,"居室選定条件",null,null,"□測定の対象となる特定測定物質の濃度が相対的に高くなることが見込まれる\n　 居室において行われている（日照が多い等）"]
[{"$nulls":5},"□その他："]
[null,null,"評価員の氏名"]
[null,null,"測定器具の名称",null,null,"□パッシブ測定器方式（バッジ式）",{"$nulls":13},"□その他"]
[null,null,"採取中の",null,null,"採取中の　□室温　　　　□平均室温",{"$nulls":16},"℃"]
[null,null,"室温・湿度",null,null,"採取中の　□相対湿度　□平均相対湿度",{"$nulls":16},"％"]
[null,null,"採取中の開口部の状況",null,null,"□外気に面する窓及び扉を閉鎖"]
[null,null,"採取中の日照の状況等"]
[null,null,"２４時間連続運転の、\n全般換気のための設備",null,null,"□品確法の全般換気設備",{"$nulls":9},"□品確法外の全般換気設備",{"$nulls":10},"□全般換気設備無し"]
[{"$nulls":5},"□稼動",null,null,null,"□否稼動",{"$nulls":5},"全般換気設備に係る給排気口の",{"$nulls":10},"□開放",null,null,null,"□閉鎖"]
[{"$nulls":5},"運転状況："]
[null,null,"冷暖房設備の運転状況",null,null,"□稼動",null,null,"□否稼動",null,null,null,"□無し",{"$nulls":7},"設定温度",{"$nulls":5},"℃"]
[{"$nulls":5},"運転状況："]
[null,null,"採取位置",null,null,"□当該居室の中央付近"]
[{"$nulls":5},"□床からの高さ　1.2～1.5ｍ"]
[null,null,"特定化学物質の\n名称及び濃度",null,null,"特定測定物質の名称",{"$nulls":17},"特定化学物質の濃度（ppm）"]
[{"$nulls":23},"最高値",{"$nulls":5},"最低値"]
[{"$nulls":5},"必須",{"$nulls":10},"■ホルムアルデヒド"]
[{"$nulls":5},"選択\n（測定の対象となるもの）",{"$nulls":10},"□トルエン"]
[{"$nulls":16},"□キシレン"]
[{"$nulls":16},"□エチルベンゼン"]
[{"$nulls":16},"□スチレン"]
[null,null,"分析した者の\n氏名又は名称"]
[]
[null,null,"その他\n特定化学物質の濃度に関する特徴的な条件"]