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Contracting Entity Name: Anita Moreau "Food Program Specialist"
CE ID # (Five Digit):
Date Meal was Served:
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Name of Site:
Site # (Four Digit):
Meal Service:
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Meal DescriptionPlanned ParticipationLeftover/Recycled Food
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Breakfast - Must serve all three components. May serve a meat/meat alternative in place of the grains 3 times a week Enrolled ChildrenTotalsDate First ServedDate Re-ServedFood Item and Quantity
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1 Year123
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Lunch - Must serve all 5 required components. 2 Year
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3-5 Years
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Supper - Must serve all 5 required components. 6-12 Years
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13-18 Years
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Snacks - Must serve 2 of the 5 components.Program Staff
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Non-Program Adults
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Required Food ComponentsMenuFood Items Used (Enter each food item used)Quantity Prepared (measurable amount)
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Milk - Unflavored Whole - 1 yearMilk
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Milk- Unflavored Low-Fat (1%) or Unflavored fat-free (skim) - 2 Yrs and Older
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Milk - Flavored fat-free (skim) - 6 years and older (optional)
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Vegetables
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FruitsApples
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GrainsToast
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Meat and/or Meat Alternate
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Substitutions due to Medical or Special dietary needs or disability
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Name of ChildSubstitution(s) MadeItem/Component Provided by Parent/Guardian- Y/N
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