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[[image: preprinted form with lines for entries]]
Survey  
Drainage
Coll. No.    RHG 169
Locality  
County  
Quadrangle  
Elevation
Water
Flow
Width
Vegetation  
Bottom
Current
Shore
Distance from shore
Temperature: 
Air
Water
Time
Weather  
Depth of Capture
Depth of Water
Method of Capture     
Date    
Collected by  
Orig. preserv     
Time     
General notes:
[[strikethrough]] Aeshna a [[/strikethrough]]
Sympetrum obtrusum - 1 [[male symbol]]