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["常州市重点监控用水单位自查表"]
[]
["单位名称："]
["取水许可证号：",null,null,"取水许可证有效期："]
["计量图片："]
[]
["年度抄表记录情况："]
[]
[]
[]
["年度用水计划下达数：","（单位：万立方米）"]
[]
["年度实际用水量：","（单位：万立方米）"]
[]
["是否通过水量平衡测试：",null,"□","是","□","否"]
["是否为水效领跑者：",null,"□","是","□","否"]
["是否为节水标杆单位：",null,"□","是","□","否"]
[]
[]
[null,null,"填报人："]
[null,null,"联系电话："]