~ PRIVACY ACT MATERIAL REMOVED
MEDICAL EVALUATION
This is to certify that I have determined that Eberline
Instrument Corporation employee,
.
-
has no unusual medical conditions or physical
impairments
that would limit hisnormal duties of employment.
Base Line Blood Counts:
White Cell with Differential
EEao?
Poy
a‘
Physician's Signature
Please type:
Tub tien MP.
Signature Name
din iaests
9119 [77
/7 Abnormal
adit
Date
// Abnormal
EaCO!f Cosh feted te
Street and No.
hfCxgrecgre UY, ETI 10
City
‘State~
292-20]
Zip
Telephone
MOVED
MATERIAL RE
PRIVACY ACT
las
Hemogtobin K Norma)
Dt Normat