TERMS INVOICE DATE PG. ALVIN WHITE mON1QUE A15 CREDIT CARD 12-16-09 1 SHIP VIA ENTERED BY TAX RESALE NO. FILLED BY CHECKED BY ORDER NO. R & L CARRIERS JTONG 30305P ITEM NO. / DESCRIPTION OTT. ORD. OTT SIIPt OTT. BM UOM UNIT PRICE TAX EXTENDED PRICE 507108 ESSX 09-097-02 24-25P PE

essure (I) Normal=N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes 5. Visual Acuity (R & L) R Aro& °row 6. Ears 7. Auditory Acuity (11 Et L) 8. Nose / Throat 1 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen V 1

ure ././r / 4 Normal-N; Abnormal-A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/NoSe 3. Head/Scab 4 Eyes 5 Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) a. Nose / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13.teirr-aal-Anirem- 14

e (✓) Normal=N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes • . 5. Mural Acuity (R & L) . 6. Ears Ii. 7. Ati0ttory Acuity1R & L) — 8. Nose / Throat 9. Mouth, Teeth and Gums 10. Chest / Lungs 1 i. Heart - 12. Abdomen 13. Geni

dings, by number 1. Appearance C < r. 2. Skin/Nose ../ 3. Head/Scalp / 4. Eyes 5. Visual Acuity IR & Ll . / 6. Ears / 7. Auditory Acuity (R & L) / 8. Nose / Throat / 9. Mouth. Teeth and Gums /,.." 10. Chest / Lungs / 11. Heart / 12. Abdomen / 4". 13. Genitals and Anus / 14. Musc

ure (1) Normal-N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes J 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 8. NOSe / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13. Genitals and Anus