PRIVACYACY ACac T MATERA),R EMOVED MEDICAL EVALUATION This is to certify that I have determined that Eberline Instrument Corporation employee, _. .. | oo has no unusual medical conditions or physical impairments that would limit his normal duties of employment. Base Line Blood Counts: White Cell with Differential Hemoglobin 7 Normal pate_5/2/95 t /f Normal // Abnormal] /7 Abnorma) as Ae Physician's Signature Please type: tL.Niller mp Signature Name | ste 6t¢o/ Coasttutta, VE Street and No. FUl brveqrerawe City State “vm ste Zip 292-20! Telephone PRIVACY ACT MATERIAL REMOVED