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