Instruction Supervisor Uniform Outfitting Form Logistics Brigade Chief Item Item # Quantity Description/Specification Size Date Issued Initials Initials Dress Uniforms

J-5 2 1/4" x 1/2" Double Name Tag Blackinton 130270 2 Clutch Back

Serving Since Blackinton 130271 2 YEAR in Gold

American Flag Pin Blackinton J 143 2 American Flag Pin Gold

Breast Blackinton B1449 2 Hi Glo - GOLD

Hat Badge for Dress Blackington BC076 1 Hi Glo - GOLD Hat

Snake Strap for Dress Snake Cap 1 Gold Hat Strap Gold, Galls

Wreath with EMS, One Star, Instruction Supervisor Collinson CINS510 2 sets 7/8", Die Struck, Clutch Back, Devices Gold (Gold) Finish

"VB" Pin for Dress 1/2" letter, Custom Blackinton Style # 5 2 Coat Lapel Combination "VB", Gold Plate

Emergency Medical Services Officer Dress Coat on White Outer , Blue Galls, Item # CB1288 2 Star of Life on Gold Background 1 3/4 Inch wide BLACK Belt Duty Man 1611U 2 Leather / Gold Buckle Law Pro/ Hero's Tie Clip Pride Item# 1 Gold Tie Clip QM4007G Flying Cross Dress Jacket w/ Men's: JA 380; 38800 Gold P Buttons & Sleeve Officer Dress Blouse Women's: JA 009; 1 striping 38833

Flying Cross Men's: 38200 Flying Cross Plain Front Men / Dress Uniform Pants 1 Women's: 38260, Women Galls

Horace Small New Dimension Men's: ZR024 Long Sleeve / Gold P Dress Shirt L/S Women's: SR682, 2 Buttons / w/Patches and White Shirt rockers

Horace Small, New Men's ZO743 Dimension Short Sleeve Shirt Dress Shirt S/S Women's: ZM149, 2 / Gold P Buttons / w/Patches White Shirt and rockers Work Uniforms Logistics Brigade Chief Item Item # Quantity Description/Specification Size Date Issued Initials Initials

Corner Stone Hi Performance Polo / Short Sleeve w/ Gold Men's: CS-412 Polo 6 Embroidery of Badge, Name Women's: CS-413 & Rank. No Screen Print on Back.

Job Shirt / Heather Gray / 1/4 5.11 Tactical Style Zip / with Gold Embrodiery of Job Shirt 3 72314 Badge, Name & Rank. No Screen Print on Back.

Elbeco Work Pants Men's: TR593 4 4 pocket Every Day Trousers Women's: TR590

Cavalier Sportswear, Baseball Cap Trucker Style, Mesh 1 Virginia Beach EMS in Gold Backing

EMS Beanie Cavalier Sportswear 1 Virginia Beach EMS in Gold

5.11 Sabre 2.0 JA 935 1 Tactical Jacket Tactical Jacket

ANSI Class 3 / Windbreaker Windbreaker / Rain CSJ 25 1 Yellow/Black / Light weight / Coat Waterproof

SPIEWAK S-911 ANSI Class 2 Hi Viz Yellow Traffic Vest 1 EMS Traffic Safety Vest

Heather Gray Tee Shirts / Tee Shirts Beefy Tee 5180 4 GOLD Badge at L Chest / Screen Print on back

Logistics Name (Printed):______

Date of Signature: ______Logistics Signature:______Brigade Chief Name (Printed):______

Date of Signature: ______Brigade Chief Signature:______

Instruction Supervisor's Name (Printed):______

Date of Signature: ______Instruction Supervisor's Signature:______