Ecologix Frac Data Request Form Company Name*First Name*Last Name* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Phone*Email* Project locationcity, state of your expected project site.Truck HaulingTruck Hauling Service UsedEnter your truck hauling serviceLocationEnter LocationTank VolumeEnter tank volumeCost Per HourEnter your cost per hour Current Wells Current Number of WellsEnter current number of wellsAverage Well DepthEnter average well depthsType of Well Drilled (Vertical, Horizontal, Fracture)Enter type of wellFreshwater Required/wellis freshwater required/wellFlowback WW/WellFlowback WW/WellWW Disposed Volume/WellWW Disposed Volume/WellCost of WW Disposal/WellCost of WW Disposal/WellVolume of Treated Effluent to be ReusedVolume of Treated Effluent to be Reused$/bbl of Treated Effluent to be reused in production$/bbl of Treated Effluent to be reused in production Future WellsFuture Number of WellsFuture Number of WellsAverage Well DepthAverage Well DepthType of Well Drilled (Vertical, Horizontal, Fracture)Type of well drilledFreshwater Required/wellFreshwater Required/wellFlowback WW/WellFlowback WW/WellWW Disposed Volume/WellWW Disposed Volume/WellCost of WW Disposal/WellCost of WW Disposal/WellVolume of Treated Effluent to be ReusedVolume of Treated Effluent$/bbl of Treated Effluent to be reused in production$/bbl of Treated Effluent to be reused in production Treated flowback constituents of concern for reuse TDSMaxMinNotesTurbidityMaxMinNotesScaling ElementsMaxMinNotesBacteriaMaxMinNotesIronMaxMinNotesOilsMaxMinNotesSolidsMaxMinNotesAdditional Notes