PRIVACY ACT MATERIAL REMOVED MEDICAL EVALUATION This is to certify that I have determined that Eberline Instrument Corporation emplovee, — - _ € __. has no unusual medical conditions or physical impairments that would limit his normal duties of employment. Base Line Blood Counts: White Cell with Differential IK Normal // Abnormal Hemoglobin Date BE Normal tle./m7 /7Abnormal -~ _ , Z ST gallon -Phystctan’sSignatur Please type: | °° apt APPS SignatureNAR&baum St. Santa Fe, New Mexico 87501 Street ‘and , City 'NGY State “dl Zip telephone PRIVACY ACT MATERIAL REMOVED