MEASUREMENTS AHO OTHER FINDINGS
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73, notss (Conanuad) any Side/FICaNT O8 UNTERVAL MIBTORY
Using beta-ganma survey meter MI-5, background reading .03 -.06 mr/br. No radicactive
contemination found.
(Uee additional setts Uf weceasnry)
Ja. SUmMaARY OF BTFECTS ant O1ewonts (List diagmesss with tiem numbers)
7S, SECOMMENDATIONS—FURTHEN SPECIALINY ExauinaTions mmolcaTeo (Specn/y)
76,
A. PHYSICAL PROFILE
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G. PHYBICAL CaTeeony
sb. Os wor quacirino For
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79. TYPED OF PRINTED MAME OF PHYSICIAN
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81. TYPED OF PRINTED MAME OF DENTIST OM PHYBICIAN Uindhonts which)
BISNATURE
O2. TYPED OR PRINTED NAME OF AEVIEWING OFFICER OR APPROVING KUTHORITY
SreMATUAL
CARL L, HANSEN, Lt Col,USAP,MOWS
e
¢
£
NUMBER OF AT=
TACWED BHELTS
CB. GOVERNMENT FRINTNE OFFICE,
BEST AVAILABLE COPY
1087 D—~ehese