oRIVAGY ACT MATERIAL REMOVED * MEDICAL EVALUATION , % This is to certify that I have determined that Eberline Instrument Corporation employee, | a > has no unusual medical conditions or physical impairments that would limit his normal duties of employment. Base Line Blood Counts: White Cell with Differential // Normal // Abnormal Hemoglobin /7 Normal /7- Abnormal Date s Physician's Signature Please type: Signature Name Street and No. City State Zip Telephone MATERIAL PRIVACY act REMOVED