Mokulele Ground Meal Order Form
PICKUP-DATE	PICKUP TIME	SQUADRON	   POC RANK AND NAME	POC PHONE #	
					
** Meals and Supplements are subject to change due to non-availability**
Please indicate meal # and supplement # in last columns.  
All meals must be consumed within 4 hours of issue	
Do ID # (ESM Only)	NAME 	GRADE 	SALES AMOUNT 	MEAL # 	Supplement #	
 
(meal card only)
	(cash sign, meal card print)	 	(cash customers only)	 	 	
 EX: 123456789	 Nathan Smith	 E-3	 	 L1	 1	
 EX: (Leave blank)	 David Robinson  	 E-7	 $6.00	 L1	 2	
 	 Collective order	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

 	 	 	 	 	 	

Meal Card Personnel: No Charge
Cash Paying Customer: $6.00
(current as of June 2021)	
Entree:	
L1	
Ham & Turkey Sub	
L2	
Turkey & Cheese Sub	
L3	
Ham & Cheese Sub	
L4	
Turkey & Bacon Croissant	
L5	
Ham & Cheese Croissant	
L6	
Buffalo Chicken Wrap	
L7	
Breaded Chicken Burger	
L8	
Breaded Chicken Tenders	
L9	
Chipotle Chicken Sandwich	
L10 Unavailable 	
“Uncrustables” PB & J Sandwich	
L11	
Chef Salad	
L12	
Breakfast Cereal w/ Milk (2ea)

SUPPLEMENTS:	
(1)	
Soda, Nutrigrain Bar, Chips
 Fresh Fruit	
(2)	
Gatorade, Nutrigrain Bar, Carrot/Celery Sticks w/ Ranch Dressing , Fresh Fruit	
(3)	
Water,  Granola Bar, Hummus w/Pretzel Chips, Fresh  Fruit	
(4)	
Orange Juice, Nutrigrain 
           Bar Boiled Eggs  (2ea),
Fresh Fruit	

Privacy Act Statement Authority: 5 U.S.C. 8013 and 8034 EO 9397
PRINCIPAL PURPOSE: To document and identify personnel that obtains meals from appropriated fund dining facilities.
DOD ID number is used to verify entitlements and for positive identification.
ADDITIONAL INFORMATION: Mokulele Flight Kitchen DSN: 449-1666 / Comm (808) 449-1666. Mokulele Flight Kitchen is located at the back of Hale Aina Dining Facility, Bldg 1860 and is open 24/7

TIME ORDER RECEIVED:                    ACTUAL PICK UP TIME:                         PICKED UP by:                 QA CHECK BY (FK USE ONLY):_________________