|
TERIALREMOVED
-| DRIVACY ACT MATERIAL
*
’
MEDICAL EVALUATION
;
a
a
|
RECE!yep-:
UL 1 31377
cor
"es pee we
cH aUINE FS
TEG ENT CARP,
Haves --
i
This is to certify that I have determined that Eberline
Instrument Corporation employee, —
—-—
-—
- oe
has no unusual medical conditions/ér physical impairments
that would limit his normal duties of employment.
Base Line Blood Counts:
White Cell with Differential /7 Normal // Abnormal
Hemoglobin Normal
Date
Wt/27
//Abnorma)
|
Nebel) E Crt VS
hysician's Signature
Please type:
hobert
£ Cutler_™-D.
Signature lame
“hoxDD
Street andio.
tol:
Fspailo|a.
tate
|
PAS. 2
DA,f, YIS3
TS3- 71 24
Telephone
PRIVACY ACT MATERIAL REMOVED
Zip
—