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(</u><u>蓋章</u><u>) </u><br /> <br /> <br /> <br /> <br /> 　　編制單位：<u> (</u><u>蓋章</u><u>) </u><br /> 　　<br /> <br /> <br /> 年月日<br /> <br /> <br /> <table align="left" border="1" cellpadding="0" cellspacing="0"> <tbody> <tr> <td colspan="3" style="width:139px;height:31px;">項目單位</td> <td colspan="9" style="width:468px;height:31px;"> </td> </tr> <tr> <td colspan="3" style="width:139px;height:30px;">建設單位</td> <td colspan="9" style="width:468px;height:30px;"> </td> </tr> <tr> <td colspan="3" style="width:139px;height:31px;">法人代表</td> <td colspan="4" style="width:168px;height:31px;"> </td> <td colspan="2" style="width:84px;height:31px;">聯系人</td> <td colspan="3" style="width:216px;height:31px;"> </td> </tr> <tr> <td colspan="3" style="width:139px;height:30px;">通訊地址</td> <td colspan="9" style="width:468px;height:30px;"> 地（州、市）市（縣）</td> </tr> <tr> <td colspan="3" style="width:139px;height:29px;">聯系電話</td> <td colspan="2" style="width:108px;height:29px;"> </td> <td colspan="3" style="width:72px;height:29px;">傳真</td> <td colspan="2" style="width:84px;height:29px;"> </td> <td style="width:84px;height:29px;">郵政編碼</td> <td style="width:120px;height:29px;"> </td> </tr> <tr> <td colspan="3" style="width:139px;height:29px;">建設地點</td> <td colspan="9" style="width:468px;height:29px;"> </td> </tr> <tr> <td colspan="4" style="width:187px;height:23px;">項目投資管理類別</td> <td colspan="2" style="width:108px;height:23px;">審批□</td> <td colspan="4" style="width:108px;height:23px;">核準□</td> <td colspan="2" style="width:204px;height:23px;">備案□</td> </tr> <tr> <td colspan="4" style="width:187px;height:30px;">項目類別</td> <td colspan="8" style="width:420px;height:30px;"> </td> </tr> <tr> <td colspan="2" style="width:79px;height:31px;">建設性質</td> <td colspan="4" style="width:216px;height:31px;">新建□ 改建□ 擴建□</td> <td colspan="4" style="width:108px;height:31px;">項目總投資</td> <td colspan="2" style="width:204px;height:31px;">　　　　　　　?。ㄈf元）</td> </tr> <tr> <td colspan="12" style="width:607px;height:134px;">工程建設內容及規模</td> </tr> <tr> <td colspan="12" style="width:607px;height:145px;">項目主要耗能品種及耗能量</td> </tr> <tr> <td rowspan="3" style="width:43px;height:144px;"> <br /> <br /> <br /> <br /> 節<br /> <br /> 能<br /> <br /> 評<br /> <br /> 估<br /> <br /> 依<br /> <br /> 據</td> <td colspan="11" style="width:564px;height:144px;">相關法律、法規等</td> </tr> <tr> <td colspan="11" style="width:564px;height:134px;">行業與區域規劃、行業準入與產業政策等</td> </tr> <tr> <td colspan="11" style="width:564px;height:95px;">相關標準與規范等</td> </tr> <tr height="0"> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> <td> </td> </tr> </tbody> </table> <br /> <table border="1" cellpadding="0" cellspacing="0" style="width:612px;" width="612"> <tbody> <tr> <td rowspan="3" style="width:48px;height:93px;">　　<br /> <br /> <br /> 能<br /> 源<br /> 供<br /> 應<br /> 情<br /> 況<br /> 分<br /> 析<br /> 評<br /> 估<br /> <br /> </td> <td style="width:564px;height:93px;">項目建設地概況及能源消費情況(單位地區生產總值能耗、單位工業增加值能耗、水耗、單位建筑面積能耗、節能目標等)<br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:83px;">項目所在地能源資源供應條件<br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:83px;">項目對當地能源消費的影響<br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td rowspan="5" style="width:48px;height:83px;">　　<br /> <br /> <br /> 項<br /> <br /> 目<br /> <br /> 用<br /> <br /> 能<br /> <br /> 情<br /> <br /> 況<br /> <br /> 分<br /> <br /> 析<br /> <br /> 評<br /> <br /> 估<br /> <br /> </td> <td style="width:564px;height:83px;">工藝流程與技術方案(對于改擴建項目，應對原有工藝、技術方案進行說明)對能源消費的影響<br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:72px;">主要耗能工序及其能耗指標<br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:71px;">主要耗能設備及其能耗指標<br /> <br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:98px;">輔助生產和附屬生產設施及其能耗指標<br /> <br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:93px;">總體能耗指標(單位產品能耗、主要工序單耗、單位建筑面積能耗、單位產值或增加值能耗等)<br /> <br /> <br /> <br /> <br /> </td> </tr> </tbody> </table> <br /> <table border="1" cellpadding="0" cellspacing="0"> <tbody> <tr> <td rowspan="2" style="width:48px;height:145px;"> <br /> <br /> <br /> <br /> <br /> 節<br /> <br /> 能<br /> <br /> 措<br /> <br /> 施<br /> <br /> 評<br /> <br /> 估<br /> <br /> <br /> <br /> </td> <td style="width:564px;height:145px;">節能技術措施分析評估(生產工藝、動力、建筑、給排水、暖通與空調、照明、控制、電氣等方面的節能技術措施)<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:564px;height:154px;">節能管理措施分析評估(節能管理制度和措施，能源管理機構及人員配備，能源計量器具配備，能源統計、監測措施等)<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> </td> </tr> <tr> <td style="width:48px;height:158px;"> <br /> 結<br /> 論<br /> 與<br /> 建<br /> 議<br /> </td> <td style="width:564px;height:158px;"> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br 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