EFTA00059588

Name of Inmate On Suicide Watch or Psych Observation: Epstein

Registration #: 76318-054



EATING/SHOWER CHART

<table><thead><tr><th>DATE</th><th>BREAKFAST</th><th>LUNCH</th><th>DINNER</th><th>LIQUIDS</th><th>OFFERED SHOWER</th><th>RECEIVED SHOWER</th></tr></thead><tbody><tr><td>7/23</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>9/24/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/25/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/26/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/27/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/28/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/29/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>7/30/19</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

Please check the appropriate box if the person on Suicide Watch/Psych Observation actually eats his meal. Do not check the box if he just received it, but did not eat it.

Place a check in the “Liquids” box each time the person drinks.

Thank you.

EFTA00059589