| 设备/物品名称 | 单位 | 数量 | |
| 1 | ____________ | ____________ | ____________ |
| 2 | ____________ | ____________ | ____________ |
| 3 | ____________ | ____________ | ____________ |
| 4 | ____________ | ____________ | ____________ |
| 5 | ____________ | ____________ | ____________ |
| 6 | ____________ | ____________ | ____________ |
| 7 | ____________ | ____________ | ____________ |
| 8 | ____________ | ____________ | ____________ |
| 9 | ____________ | ____________ | ____________ |
| 10 | ____________ | ____________ | ____________ |