a.

PRIVACY. ACT MATERIAL REMOVED

2

OS

408051

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ome
»

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MEDICAL EVALUATION

This is to certify that I have determined that Eberline
Instrument Corporation employee,

ook

a

ms

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 /X Normal

AX Normal

// Abnormal

/7 Abnormat
/
Lou!s H. ZUCA
L, M.D. P.C,
5 Signatur
es Bisa Street
sorts pe te
Mes 87504
"th

Please type:

Louis H. Zucal,MD P.C.

Signature Name. 1300 Taisa St

Street and No.

Santa Fe, New Mexico 87501
City
State |
Zip

SOS

telephone

283 4O4G

PRIVACY ACT MATERIAL REMOVED

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