DIME - Test Card

Test Card

Number of Tests: *

Tester's full name *

____________

Date of test *

____ / ____ / ____ (Month / Day / Year)

Gage No. *

____________

Nuclear gauge serial number

Test No. *

____________

Depth *

____________ in

Gauge transmission depth

Material from *

____________

i.e. source, vendor, job site, or native

Material type *

____________

Classification of material (i.e. Class II AB, embankment, subgrade, etc.)

Impact test performed by *

____________

Person who performed impact test (CT216)

Impact date *

____ / ____ / ____ (Month / Day / Year)

Date the impact test was performed

Standard count density *

____________

Density *

____________ g/cc

Density Count *

____________

Background Count *

____________

Wet Density or Adjusted Density *

____________ g/cc

From CT 216

General comments (publicly viewable) (Max 1000 characters)

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Project test result compliance comments (Max 1000 characters)

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Test result compliancecomplies does not comply not applicable (Circle One)