North Carolina Department of Environment and Natural Resources 

Division of Energy, Mineral, and Land Resources 

Energy Section - Oil and Gas Program

1612 Mail Service Center, Raleigh, NC 27699-1612 

Phone: (919) 707-9220 

Fax: (919) 715-8801 

Email: DEMLRoilandgas@ncdenr.gov

Page

Form 

18 

Rev 03/2015 Document ID:

Date:

Received by:

Well Stimulation Report

Permittee Name:

Company Name:

Address:

City:

Phone:

Fax:

Email:

State: Zip:

API Number:

Lease/Well 

Name:

Well Number:

County:

Nearest Town/

City:

Well site Ingress/

Egress Location:

Oil & Gas Program Use Only

Type of Well:

Oil

Gas

Dry

* Other

Strat.

Attachments: Permittee DEMLR-OGP

Cement Ticket

Wireline Logs

Pressure Tests

Wellbore Diagram

Gas Analysis

Form 18A

15A NCAC 05H .1624

* Describe Other Type of Well:

The following well stimulation treatment data shall be attached as a 

supplemental document by email or hardcopy:

 

1. Surface injection pressure, in pounds per square inch (psi); 

2. Slurry pumping rate in barrels per minute (BPM); 

3. Proppant concentration in pound per thousand gallons; 

4. Fluid pumping rate in BPM; 

5. Identities, rates, and concentrations of additives used in accordance 

with Rule .1702; and 

6. All annuli pressures.

Check to indicate documentation is attached.

Provide file name if attached by email:
API Number: Form 18 - Well Stimulation Report Permittee Name:

Page

Hydraulic 

Fracturing 

Stage

Type of Base Fluid

Total Volume of 

Base Fluid Used in 

Each Stage 

(Bbls)

Type of Stimulation 

Fluid 

(Additives)

Total Volume of 

Stimulation Fluid 

Used in Each 

Stage 

(Bbls)

Total Volume of 

Proppant Used 

in Each 

Stage 

(lbs)

Maximum 

Pump Pressure 

for Each 

Stage 

(psi)

Fluid & Proppant Information:

Total Volume of Base Fluid Used to Stimulate the Well (Bbls):

If hydraulic fracturing is proposed, provide the estimated maximum fracture height and length and estimated true vertical depth to the 

top of the fracture achieved during well stimulation as determined by a three dimensional model using true treating pressures and 

other supporting data collected during the hydraulic fracturing treatment:

Perforation Information:

Top of Perforations: 

(True vertical and measured depths)

Bottom of Perforations: 

(True vertical and measured depths)

Total Number of Perforations:

Diameter of Perforations:

* To report additional hydraulic fracturing 

stages, attach Form 18A.

* Attach Form 18A, if applicable by email or hardcopy.

Provide file name if attached by email:

Check to indicate documentation is attached.
API Number: Form 18 - Well Stimulation Report Permittee Name:

Page

Test Information:

Test Date: 

Duration of Test:

Test Method:

Quantity of Oil (Bbls):

Quantity of Water (Bbls):

Quantity of Gas (MCF):

Casing Pressure (psi):

Tubing Pressure (psi):

Gas Analysis Information:

Initial gas analysis, performed by a laboratory certified by the State in accordance with 15A NCAC 02H .0800:

Attach a wellbore diagram that includes casing and cement 

data, and perforations by email or hardcopy with this form.

Provide file name if attached by email:

Check to indicate documentation is attached.

Provide file name if attached by email:

Check to indicate documentation is attached.

Attach a stimulation summary by email or hardcopy with 

this form
API Number: Form 18 - Well Stimulation Report Permittee Name:

Page

Date:

Title:

Signature:

Print Name:

This form must be signed by the permittee or an authorized agent of the permittee.

Number of 

Engines Type of Engine 

Horsepower of Engine 

Less than 750 hp 

(Yes or No)

Max. Site Rated Horsepower

Hours of 

Use at the 

Well Site 

Air Quality Emissions Reporting: