few dg Lr 4 J fs fea, eC MOl Corerpureed fe IE 6 ere eer PRIVACY ACT MATERIAL REMOVED MEDICAL EVALUATION This is to certify that I have determined that Eberline Instrument Corporation employee, | . has no unusual medical conditions or physical impairments that would limit his normal duties of employment. Base Line Blood Counts: White Cell with Differential Hemoglobin Date C//¢(17 £/Normal //Normal // Abnormal // Abnormal -< LEes aw. Physician's Signature Please type: VT.“et Mes rnp. Signature Name Street and fo. All biGuirrerre , rer City State — Lip GIF -2TA -LFO/ Telephone MATERIAL PRIVACY ACT D | REMOVED $S71le