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[null,null,"    ※溶剤の選択"]
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[null,null,"　Q1.ランドリー排水の浄化装置を設備していますか？"]
[]
[null,null,"　Q2.ランドリー排水の排出先は公共用水域(河川等)か、下水道か？"]

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["別記様式"]
["第一種指定化学物質の排出量及び移動量の届出書"]
[{"$nulls":8},"　　　　　        年    月    日"]
["　主務大臣(都道府県知事) 殿",{"$nulls":5},"(ふりがな)"]
[{"$nulls":5},"届出者","住　所　〒"]
[{"$nulls":6},"(ふりがな)"]
[{"$nulls":6},"氏　名",null,null,"印"]
[{"$nulls":6},"(法人にあっては名称及び代表者の氏名)"]
["　特定化学物質の環境への排出量の把握等及び管理の改善の促進に関する法律第5条第2項の規定により"]
["、第一種指定化学物質の排出量及び移動量について、次のとおり届け出ます。"]
[]
["事業所","(ふりがな)"]
[null,"事業者の名称"]
[null,"前回届出における名称"]
[null,"(ふりがな)"]
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[null,null,"うち主たるもの"]
[]
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["第一種指定化学物質の排出量及び移動量",{"$nulls":6},"別紙番号1～ のとおり"]
["本届出が法第6条第1項の請求に係るものであることの有無",{"$nulls":6},"1.有"]
["(該当するものに○をすること)",{"$nulls":6},"2.無"]
["担当者","部　　署"]
["(問い合\nわせ先)","(ふりがな)"]
[null,"氏　　名"]
[null,"電話番号"]
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["備考","1　本届出は、事業所ごとに作成すること。"]
[null,"2　前回の届出における名称の欄は、変更された場合のみ記載すること。"]
[null,"3　事業所において常時使用される従業員の数の欄には、前年4月1日現在(前年度中に事業を開始した事業"]
[null,"　者においては事業を開始した日)における当該事業所の人数を記載すること。"]
[null,"4　事業所において行われる事業が属する業種の欄には、当該事業所における主たる事業が属する業種を最"]
[null,"　上欄に記載し、二以上の業種に属する事業を行う事業所にあっては、次欄以降にその他の業種を記載する"]
[null,"　こと。また、業種コードの欄には、業種に対応する日本標準産業分類における分類番号を記載すること。"]
[null,"5　法人にあっては、当該届出に係る当該事業所の担当部署並びに氏名及び連絡先を記載すること。"]
[null,"6　※の欄には、記載しないこと。"]
[null,"7　届出書及び別紙の用紙の大きさは、日本工業規格A4とすること。"]
[null,"8　氏名（法人にあってはその代表者の氏名）を記載し、押印することに代えて、本人（法人にあってはその代"]
[null,"　表者）が署名することができる。",{"$nulls":5},""]
[""]

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["別紙番号"]
[]
["第一種指定化学物質の名称並びに排出量及び移動量"]
[]
["第一種指定化学物質の名称"]
["第一種指定化学物質の号番号",{"$nulls":14},"単位(該当するものに○を\nすること)",null,null," 1.　kg\n 2.　mg-TEQ"]
["排出量",null,null,"イ　大気への排出"]
[{"$nulls":3},"ロ　公共用水域への\n　　排出",{"$nulls":11},"排出先の河川、湖沼、\n海域等の名称"]
[{"$nulls":3},"ハ　当該事業所における\n　　土壌への排出\n　　（二以外）"]
[{"$nulls":3},"二　当該事業所における\n　　埋立処分",{"$nulls":11},"埋立処分を行う場所\n(該当するものに○を\nすること)",null,null,"1.　安定型\n2.　管理型\n3.　遮断型"]
["移動量",null,null,"イ　下水道への移動"]
[{"$nulls":3},"ロ　当該事業所の外へ\n　　の移動（イ以外）"]
["※整理番号"]
[null,null,""]
["備考",null,"1　特定第一種指定化学物質についても本別紙を用いること。"]
[null,null,"2　本別紙は、第一種指定化学物質ごとに作成することとし、別紙番号の欄に令別表第一に掲げる第一種指定化学"]
[null,null,"   物質の順に番号を割り振ること。"]
[null,null,"3　第一種指定化学物質の名称の欄及び第一種指定化学物質の号番号の欄には、令別表第一に掲げる名称（令別"]
[null,null,"　表第一に別名の記載がある第一種指定化学物質にあっては、当該別名)及び号番号を記載すること。"]
[null,null,"4　排出量及び移動量の単位は、ダイオキシン類以外の第一種指定化学物質については「kg」、ダイオキシン"]
[null,null,"　類については「mg-TEQ」を選択すること。"]
[null,null,"5　排出量及び移動量の有効数字は2桁とすること。ただし、ダイオキシン類以外の第一種指定化学物質に"]
[null,null,"　あっては、排出量又は移動量が1kg未満の場合、小数点以下第2位以下を四捨五入して得た数値を記載す"]
[null,null,"　ることとする。"]
[null,null,"6　公共用水域への排出がある場合、排出先の河川、湖沼、海域等の名称の欄には排出先の名称を記載す"]
[null,null,"　ること。"]
[null,null,"7　※の欄には、記載しないこと。"]