O DP &2P •acoo/ (An pan; • 14011 foil r -4'051 ags : (Mr . S=S l k• 0.e.; 5. 8:21' cSt .••••:. • 4. EFTA00132880 11100 MW TORk WOO ROW TOM( IPECIRIMOUTIRG raft MCC NEW YORK SPECIAL HOUSING UNIT 30 MINUTE CHECK SHEET ZI3 DATE: / Maill110111104VAIT TIME RAME i IML START TIME END SIGNATURE T