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

Production Well Projects Only

Project Area Data

Pattern type:   Spacing:

Source of water breakthrough (check all that apply):

     Bottom Water Drive   Edge Water Drive   Injected

Number of producing wells in project area:

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:

Initial Oil/Water Production Rate:

Current Oil/Water Production Rate:

Cumulative Oil Production:

Type of Pumping System:

Fluid Level in Wellbore:

Production Zone Thickness:

Last Acid Treatment:

Treatment Objectives: 

Post Treatment Oil Rate:

Post Treatment Water Rate: