PRIVACY ACTMATERIAL RE

MOVED

ay

.

MEDICAL EVALUATION

This is to certify that I have determined thatEberline

Instrument Corporation employee, _.,

_ 7

-

has no unusual medica} conditions dr physical ‘Impairments
that would limit his normal duties of employment.
Base Line Blood Counts:

White Cell with Differential
Hemoglobin J¥ Normal

Date 6~ 22-7 /

Z

Af Normal

/7 “,

'

// Abnormal

|

-

tyne MWhsrtMP

Physician's Psnature f

a

piéase type:
Signature Name
Street and No.
City

State

) Zip

Telephone
JAMES J. SHARIPE. FAL D.

4.
1512 TEXAS ST,N, 5.
ALBQIMQUaZ NEW MEXICO &7i1e

PRIVACY ACT MATERIAL REMOVED

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