Location:

Company Contacts:

Name:   Title:   

Telephone:

Name:   Title:   

Telephone:

Field Location (County, State, etc.):

Formation Characteristics:

Name:      Lithology:

Reservoir Temperature:      

Drive Mechanisms:

Reservoir Pressure:      

Water/Oil or Gas/Oil Contact Depth:

Average Permeability:      Average Porosity:

Connate Water Saturation %:      Residual Oil Saturation:

Clay Types:

Is the zone of interest described as (check all that apply):

     Fractured   Vugular   Homogenous   Induced Fractures

Additional Comments:

Important — please include the following:

• Profile/Production log of the interval
• Wellbore schematic

Profile Modification Projects Only

Project Area Data

Year injection started:   Pattern type:   Spacing:

Number of injection wells in project area:

Number of producing wells in project area:

How has the reservoir responded to fluid injection?

Well Data (Please complete a separate form for each well submitted)
Include a copy of logs through this completion interval and a completion schematic.

Completion Date:

Completion Type:

Perforated Intervals:

Wellhead Injection Pressure:

Bottom Hole Pressure:

Average Injection Rate:

Cumulative Injection:

Bottom Hole Temperature:

Zonal Height:

Date of Last Profile Log:

Thief Zone Description: