Phoenix Chemical Corp.
16541 Redmond Way # 212C
Redmond, WA 98052
TEL 425-306-6776
FAX 425-449-4947

Well Data Form

Fields in bold are required
Company Name:
Primary Contact:
Phone No.
Fax No.
Do you have an immediate application
for PARC400® Chemical?
Yes No
Brief description of inquiry:
1. Well #./Name:
2. Field Name:
3. Formation Type & Name:
4. Age of Well:

5. Estimated depth of Paraffin / Asphaltene:

6. Paraffin / Asphaltene in the flowline:

Yes  No
7. Do you pig the flow line: Yes  No

8. Do you suspect formation plugging or  damage
    due to Paraffin / Asphaltene:

Yes  No
9. API gravity of oil:
10. Bottom hole temperature:
11. Bottom hole pressure:
12. Daily oil production bbl/m3:
13. Daily water production bbl/m3:
14. Daily gas production MCF/decs.:
15. Number of perforation zones:
16. Perforation depth from ft/m to ft/m:
17. Well T.D. ft/m:
18. Tubing T.D. ft/m:
19. Casing size = mm/inches:
20. Tubing size = mm/inches:
21. Packer in well: Yes  No
22. Pumping or flowing well:  Pumping  Flowing
23. Type of pump used:

24. Oil & water produced up:

Casing  Tubing
25. Open hole or casing: Open   Casing

26. Previous 6 month production history:

27. Drive mechanism: Electric  Gas  Other
28. Previous treatments used: Hot Oil   Chemical None
29. Frequency of previous treatments:
30. Relative success of previous treatments:
31. Appx. Cost of previous treatments:
32.  Is the well's hydrostatic pressure easilyoffset to inject treating fluid into the formation: Yes  No

33.  Estimated amount of fluid and pressure to inject fluid into the formation: