| TERIALREMOVED -| DRIVACY ACT MATERIAL * ’ MEDICAL EVALUATION ; a a | RECE!yep-: UL 1 31377 cor "es pee we cH aUINE FS TEG ENT CARP, Haves -- i This is to certify that I have determined that Eberline Instrument Corporation employee, — —-— -— - oe has no unusual medical conditions/ér physical impairments that would limit his normal duties of employment. Base Line Blood Counts: White Cell with Differential /7 Normal // Abnormal Hemoglobin Normal Date Wt/27 //Abnorma) | Nebel) E Crt VS hysician's Signature Please type: hobert £ Cutler_™-D. Signature lame “hoxDD Street andio. tol: Fspailo|a. tate | PAS. 2 DA,f, YIS3 TS3- 71 24 Telephone PRIVACY ACT MATERIAL REMOVED Zip —