## 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

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# 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:Form 18 - Well Stimulation Report API Number: 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.Form 18 - Well Stimulation Report API Number: Permittee Name:

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## 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 formForm 18 - Well Stimulation Report API Number: 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: