Company
Address
Telephone
FAX
E-Mail
Website
Contact Person
Project Name
Flood Date If Known
State	AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
Country
Reservoir Name		Sandstone Limestone
Flood Date If Known
Number of Injection Wells
Number of Production Wells
Total Barrels of Water Injected Daily
PSI
Total Produced BOPD
Total Produced BWPD
Is Injection Water From:	Supply Well Recycled Both
Are Injection Wells Metered?	Yes No
Is Injection/Production Stable?	Yes No
Chemical Program
Acre Well Spacing
Average Well Depth
Water Analyses For:	Injection Water Production Water None
Can Production From Specific Production Wells Be Accurately Measured?	Yes No
Is Injection System Accessible For Treatments?	Yes No
Downhole Temperature In Celsius:
Injection Wells
ProductionWells
Evidence Of:	Iron Sulfide Hydrogen Sulfide Gas(H2S)
ppm
Initial Completion	Hydraulic Fracture Other
Injection or Production Problems