_
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PRIVACYACT MATERIAL RE
s
MOVED
KEDICAL EVALUATION
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.
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This is to certify that I have determined that Eberline
Instrument Corporation employee,
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has no unusual medical conditions or physical impairients
,
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential
Hemoglobin
Date
f
ff formal
0-31-97
//formal
// Abnormal,
// Abnormal
see ata-ched revert
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Physician's
Signature
Please type:
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Lee
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Signature Name
tier gre, 4. 0.
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,
1
tN "999 Frivviaw Street and Ho.
"eranecla, Nev wastes
City
State:
Zip
ROS) FRR. 4A
Telephone
RIAL REMOVED
PRIVACY ACT MATE
PRA