外省(省内跨地区)建设工程质量 检测机构资质备案表26.doc

附件3 编号：外省（省内跨地区）建设工程质量检测机构资质备案表企业名称： 企业地址： 日 期： 贵 州 省 建 设 厅 制说 明 1.本表用于外省检测机构入黔备案和省内检测机构跨地区备案填写。2检测机构入黔承接检测任务的，需持检测机构入黔介绍信、近2年不良记录证明、建设工程质量检测机构资质证书、企业法人营业执照、计量认证证书到贵州省建设厅和当地地级建设行政主管部门备案；省内跨地区检测机构应到当地地级建设行政主管部门备案。3检测机构备案时需填写本备案表一式二份和电子文档一份，表中所有单位名称均应填写全称。4检测机构对备案表内容的真实性负责。 5企业填写本表时应用计算机打印，本表可在贵州建设信息网（）下载后用A4纸打印。 表1 检 测 机 构 基 本 情 况 企业名称经济性质主管部门成立时间资质证号批准部门联系电话联系人邮政编码资质范围专项检测资质范围见证取样资质检测范围法定代表人情况姓 名年龄文化程度职 称性别联系电话技术负责人情况姓 名年龄文化程度职 称性别联系电话表2-1驻黔（当地）机构和管理人员情况驻黔（当地）机构情况 名称联系电话地址邮政编码驻黔（当地）机构负责人情况姓名年龄文化程度职称性别联系电话驻黔（当地）机构技术负责人情况姓名年龄文化程度职称性别联系电话近三年检测情况及主要业绩驻黔（当地）机构所有管理人员情况 姓 名出生年月性 别学 历专 业职 称职 务表3建设工程质量检测机构资质备案情况 4检测机构工作场所配置：（布置、面积是否符合要求）技术人员配置：（人数，职称是否符合要求）设备配置：（主要设备是否符合要求）地级建设行政主管部门意见：（对省内跨地区机构备案）（盖章）年 月 日省级建设行政主管部门意见：（只对省外机构备案）（盖章）年 月 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