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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 AdultsTotalsDate First ServedDate Re-ServedFood Item and Quantity
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Enrolled455/18/20225/19/20221/2 gallon of 1% milk
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Lunch - Must serve all 5 required components. Program Staff
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Non-Program
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Supper - Must serve all 4 required components. Milk is optional.
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Snacks - Must serve 2 of the 5 components.
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Required Food ComponentsMenuFood Items Used (Enter each food item used)Quantity Prepared (measurable amount)
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Milk1% Milk1% Milk Gallon3 gallons
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VegetablesGreen BeansNo. 10 Can (101 oz) Fancy Cut Green Beans1.5 cans
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FruitsPineapplesNo. 10 Can (106 oz) Pineapple Chunks in Juice1.5 cans
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Grains (2 Servings)Wheat Bun100% Whole Wheat Bun (1 bun=2.5 oz)45 buns
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Meat and/or Meat AlternateGround Beef80/20 cooked ground beef in sloppy joe sauce5.75 pounds
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Substitutions due to Medical or Special dietary needs or disability
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Name of ParticipantSubstitution(s) MadeItem/Component Provided by Participant - Y/N
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John SmithLactose Free 1% MilkNo
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