~ 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 hisnormal duties of employment. Base Line Blood Counts: White Cell with Differential EEao? Poy a‘ Physician's Signature Please type: Tub tien MP. Signature Name din iaests 9119 [77 /7 Abnormal adit Date // Abnormal EaCO!f Cosh feted te Street and No. hfCxgrecgre UY, ETI 10 City ‘State~ 292-20] Zip Telephone MOVED MATERIAL RE PRIVACY ACT las Hemogtobin K Norma) Dt Normat