Perfect Empowered Drinking Water

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1 Perfect Empowered Drinking Water CT, NY Redemption Centers & Oregon Redemption Form State Page Number Total Pages Connecticut - CT 1, 2 2 New York - NY Oregon, OR See Return Form on page 9 Connecticut Centers to Redeem Perfect Water Bottles Store Name Street Address City State IGA ROUTE 202 BANTAM CT ROGER'S MARKETPLACE 45 CHAMBERLAIN HIGHWAY BERLIN CT STOP & SHOP 1135 FARMINGTON AVE BERLIN CT STOP & SHOP 313 COTTAGE GROVE ROAD BLOOMFIELD CT CARONS CORNER 147 MONTOWESE STREET BRANFORD CT PRICE RITE 164 BOSTON AVENUE BRIDGEPORT CT STOP & SHOP 2600 MADISON AVENUE BRIDGEPORT CT STOP & SHOP 2145 FAIRFIELD AVENUE BRIDGEPORT CT ADAM'S 100 NORTH MAIN STREET BRISTOL CT CLARION HOTEL 42 CENTURY DRIVE BRISTOL CT SHOPRITE 1200 FARMINGTON AVENUE BRISTOL CT STOP & SHOP 597 FARMINGTON AVENUE BRISTOL CT ADAM'S ROUTE 44 CANTON VILLAGE CANTON CT STOP & SHOP 215 E. MAIN STREET CLINTON CT WESTCHESTER MARKET PLACE 493 WESTCHESTER ROAD COLCHESTER CT HIGHLAND PARK MARKET 1721 BOSTON TURNPIKE COVENTRY CT PRICE RITE 136 BERLIN ROAD CROMWELL CT STOP & SHOP 195 WEST STREET CROMWELL CT STOP & SHOP 72 NEWTOWN ROAD DANBURY CT TRADER JOE'S 113 MILL PLAIN ROAD DANBURY CT PALMER'S MARKET 264 HEIGHTS ROAD DARIEN CT TRADER JOE'S 440 BOSTON POST ROAD DARIEN CT STOP & SHOP 1092 KILLINGLY COMMONS DRIVE DAYVILLE CT ADAM'S 193 MAIN STREET DEEP RIVER CT ADAM'S 656 NEW HAVEN AVENUE DERBY CT STOP & SHOP 940 SILVER LANE EAST HARTFORD CT STOP & SHOP 54 HAZARD AVENUE ENFIELD CT STOP & SHOP 760 VILLA AVE FAIRFIELD CT TRADER JOE'S 2258 BLACK ROCK TURNPIKE FAIRFIELD CT BJ'S 40 BLACK ROCK TPKE FAIRFIELD CT STOP & SHOP 11 GLEN RIDGE ROAD GREENWICH CT STOP & SHOP 161 WEST PUTMAN AVENUE GREENWICH CT STOP & SHOP 220 ROUTE 12 GROTON CT PRICE RITE 1869 DIXWELL AVENUE HAMDEN CT STOP & SHOP EMCON CENTER DIXWELL AVENUE HAMDEN CT STOP & SHOP 150 NEW PARK AVENUE HARTFORD CT STOP & SHOP 136 SAMSON ROCK DRIVE MADISON CT SHOPRITE 214 SPENCER STREET MANCHESTER CT BJ'S 1046 TOLLAND TURNPIKE MANCHESTER CT J&J LIQUORS 325 CHAMBERLAIN HIGHWAY MERIDEN CT SHOPRITE 533 SOUTH BROAD STREET MERIDEN CT STOP & SHOP BROAD STREET & EAST MAIN MERIDEN CT FOUR CORNERS 600 MIDDLEBURY ROAD MIDDLEBURY CT STOP & SHOP 416 E. MAIN STREET MIDDLETOWN CT

2 ADAM'S 1391 NEW HAVEN AVENUE MILFORD CT STOP & SHOP 855 BRIDGEPORT AVENUE MILFORD CT STOP & SHOP MONROE TURNPIKE, ROUTE 111 MONROE CT STOP & SHOP 2020 NORWICH-NEW LONDON TPKE MONTVILLE CT PRICE RITE 150 COLUMBUS BOULEVARD NEW BRITAIN CT WALTER STEWART 229 ELM STREET NEW CANAAN CT STOP & SHOP ROUTE 7 & DODD ROAD NEW MILFORD CT STOP & SHOP 248 FLANDERS ROAD NIANTIC CT STOP & SHOP 79 WASHINGTON AVENUE NORTH HAVEN CT BJ'S 555 UNIVERSAL DRIVE NORTH HAVEN CT SODAMAN 556 WESTPORT AVENUE NORWALK CT STOP & SHOP 385 CONNECTICUT AVENUE NORWALK CT STOP & SHOP 380 MAIN STREET (RTE 7) NORWALK CT COFFEE'S COUNTRY 169 BOSTON POST ROAD OLD LYME CT STOP & SHOP 259 BULL HILL LANE ORANGE CT TRADER JOE'S 560 BOSTON POST ROAD ORANGE CT STOP & SHOP 91 VOLUNTOWN ROAD, ROUTE 91 PAWCATUCK CT STOP & SHOP 125 DANBURY ROAD RIDGEFIELD CT STOP & SHOP 80 TOWN LINE ROAD ROCKY HILL CT VALERO 674 CROMWELL AVENUE ROCKY HILL CT ADAM'S 200 LEAVENWORTH ROAD SHELTON CT GARDINER'S MARKET 868 MAIN STREET SOUTH GLASTONBURY CT STOP & SHOP ROUTE 6 SOUTHBURY CT STOP & SHOP 505 NORTH MAIN STREET SOUTHINGTON CT STAFFORD FOOD 37 WEST MAIN STREET STAFFORD SPRINGS CT STOP & SHOP 1937 WEST MAIN STREET STAMFORD CT STOP & SHOP 200 E. MAIN STREET STRATFORD CT BJ'S 955 FERRY BLVD STRATFORD CT ADAM'S 201 MAIN STREET TERRYVILLE CT PRICE RITE 681 MAIN STREET TORRINGTON CT STOP & SHOP 211 HIGH STREET TORRINGTON CT BJ'S 1288 EAST MAIN STREET TORRINGTON CT STOP & SHOP 40 QUALITY STREET TRUMBULL CT STOP & SHOP 1799 FARMINGTON AVENUE UNIONVILLE CT WHOLE FOODS 50 RAYMOND STREET W HARTFORD CT PRICE RITE 983 NEW BRITAIN AVENUE W HARTFORD CT TRADER JOE'S 1489 NEW BRITAIN AVENUE W HARTFORD CT BJ'S 587 NEW PARK AVENUE W HARTFORD CT BJ'S 1040 NORTH COLONY ROAD WALLINGFORD CT COMPARE FOODS 155 THOMASTON AVE WATERBURY CT SHOPRITE 943 WOLCOTT STREET WATERBURY CT TOWN PLOT 286 FAIRFIELD AVENUE WATERBURY CT BJ'S 344 REIDVILLE ROAD WATERBURY CT STOP & SHOP 117 BOSTON POST ROAD WATERFORD CT BJ'S 125 CROSS ROAD WATERFORD CT ADAM'S 1167 MAIN STREET WATERTOWN CT STOP & SHOP 410 ELM STREET WEST HAVEN CT TRADER JOE'S 400 POST ROAD EAST WESTPORT CT PRICE RITE 160 SILAS DEAN HIGHWAY WETHERSFIELD CT BJ'S 1589 WEST MAIN STREET WILLIMANTIC CT PRICE RITE 590 WINDSOR AVE (RT 159) WINDSOR CT

3 New York Centers to Redeem Perfect Water Bottles BJ'S 1440 CENTRAL AVENUE ALBANY NY FOODTOWN (PSK) ROUTE 22 AMENIA NY STOP & SHOP 351 MERRICK ROAD AMITYVILLE NY QUALITY MARKETS 8 PROSPECT STREET & ROUTE 8 ATTICA NY ASSOCIATED 1197 GRAND AVENUE BALDWIN NY PENN TRAFFIC 2265 DOWNER ROAD BALDWINSVILLE NY PENN TRAFFIC 8417 OSWEGO ROAD BALDWINSVILLE NY PENN TRAFFIC 404 WEST MORRIS STREET BATH NY KING KULLEN 834 SUNRISE HIGHWAY BAY SHORE NY KING KULLEN 440 EAST MAIN STREET BAY SHORE NY SHOPRITE 1905 SUNRISE HIGHWAY BAY SHORE NY STOP & SHOP 533 MONTAUK HIGHWAY BAY SHORE NY IGA 68 BAYVILLE AVENUE BAYVILLE NY KING KULLEN 598 STEWART AVENUE BETHPAGE NY KING KULLEN 29 MONTAUK HIGHWAY BLUE POINT NY BOICEVILLE ROUTE 28 BOICEVILLE NY KING KULLEN SNAKE HOLLOW RD, 2044 MONTAUK HWY BRIDGEHAMPTON NY A.J. MARKET 1100 ALLERTON AVENUE BRONX NY ASSOCIATED 1757 RANDALL AVENUE BRONX NY ASSOCIATED 40 WEST BURNSIDE AVENUE BRONX NY BEST WAY 1320 ZEREGA AVENUE BRONX NY C-TOWN 2891 SEDGWICK AVENUE BRONX NY KEY FOOD 1994 BRUCKNER BLVD BRONX NY KEY FOOD 3151 WESTCHESTER AVENUE BRONX NY KEY FOOD 751 LYDIG AVENUE BRONX NY KEY FOOD 2722 EAST TREMONT AVENUE BRONX NY KEY FOOD 4171 WHITE PLAINS ROAD BRONX NY KEY FOOD 1535 UNIONPORT ROAD BRONX NY KEY FOOD 1511 METROPOLITAN AVENUE BRONX NY MET FOOD 256 EAST 167TH STREET BRONX NY NESTLE WATERS RVM 908 SOUTHERN BOULEVARD BRONX NY STOP & SHOP 691 CO-OP CITY BOULEVARD BRONX NY BJ'S 610 EXTERIOR STREET BRONX NY C-TOWN 1188 FLATBUSH AVENUE BROOKLYN NY C-TOWN WYCKOFF AVENUE BROOKLYN NY DYKER HEIGHTS TH AVENUE BROOKLYN NY GRISTEDE'S 101 CLARK STREET BROOKLYN NY KEY FOOD 7000 NEW UTRECHT AVENUE BROOKLYN NY KEY FOOD 4320 FIFTH AVENUE BROOKLYN NY KEY FOOD 224 MCGUINNESS BOULEVARD BROOKLYN NY KEY FOOD 120 5TH AVENUE BROOKLYN NY KEY FOOD 505 NEPTUNE AVENUE BROOKLYN NY KEY FOOD 2326 NOSTRAND AVENUE BROOKLYN NY KEY FOOD (FOOD KINGDOM) 3485 NEPTUNE AVENUE BROOKLYN NY MET FOOD TH AVENUE BROOKLYN NY PIONEER AVENUE H BROOKLYN NY STOP & SHOP 1710 AVENUE Y BROOKLYN NY STOP & SHOP 1009 FLATBUSH AVENUE BROOKLYN NY BJ'S 339 GATEWAY DRIVE BROOKLYN NY QUALITY MARKETS 5274 MAIN & UNION BUFFALO NY PRICE RITE 1716 KENMORE AVENUE BUFFALO NY PRICE RITE 250 ELMWOOD AVENUE BUFFALO NY PECK'S MARKET 9 LOWER MAIN STREET CALLICOON NY PENN TRAFFIC ROUTE 13 CAMDEN NY PENN TRAFFIC KASSON ROAD & ROUTE 5 CAMILLUS NY PENN TRAFFIC ROUTE 5 AND OXBOW ROAD CANASTOTA NY PENN TRAFFIC 111 EAST MAIN STREET CANTON NY STOP & SHOP 95 OLD COUNTRY ROAD CARLE PLACE NY PENN TRAFFIC 60 HIGH STREET CARTHAGE NY PENN TRAFFIC TOWN & COUNTRY PLAZA-ROUTE 20 CAZENOVIA NY KING KULLEN 522 MAIN STREET CENTER MORICHES NY H&H DISTRIBUTORS 70 WEST SUFFOLK AVENUE CENTRAL ISLIP NY BORDERVIEW 2018 RIDGE ROAD CHAMPLAIN NY

4 PENN TRAFFIC 800 W GENESEE STREET CHITTENANGO NY BJ'S 4145 ROUTE 31 CLAY NY BJ'S TH AVENUE COLLEGE POINT NY MEAT FARM (COMP) 134 COMMACK ROAD COMMACK NY KING KULLEN 120 VETERANS HIGHWAY COMMACK NY TRADER JOE'S 5070 JERICHO TURNPIKE COMMACK NY PENN TRAFFIC 5 COMMONS DRIVE, ROUTE 38 COOPERSTOWN NY STOP & SHOP 275 MIDDLE COUNTRY ROAD CORAM NY PENN TRAFFIC ROUTES 81 & 13 CORTLAND NY PENN TRAFFIC 184 HOMER AVENUE CORTLAND NY KING KULLEN MAIN ROAD CUTCHOGUE NY FOODTOWN (PSK) ROUTE 22 DOVER PLAINS NY QUALITY MARKETS D&F PLAZA 1170 CENTRAL AVE DUNKIRK NY DANS BIG M 5531 ROUTE 28 EAGLE BAY NY IGA 92 NORTH MAIN STREET EAST HAMPTON NY STOP & SHOP 2650 SUNRISE HIGHWAY EAST ISLIP NY STOP & SHOP 2525 HEMPSTEAD TURNPIKE EAST MEADOW NY LARKFIELD IGA 301 CLAYPITTS ROAD EAST NORTHPORT NY STOP & SHOP 3126 JERICHO TURNPIKE EAST NORTHPORT NY STOP & SHOP 158 ROUTE 25 A EAST SETAUKET NY BJ'S 2 CHEVY DRIVE EAST SYRACUSE NY KING KULLEN 25 EASTPORT MANOR ROAD EASTPORT NY PECK'S MARKET 9 PROCTOR ROAD ELDRED NY MET FOOD JUNCTION BOULEVARD ELMHURST NY PENN TRAFFIC 1600 CEDAR STREET ELMIRA NY QUALITY MARKETS 110 SOUTH WORK STREET FALCONER NY ASSOCIATED MOTT AVENUE FAR ROCKAWAY NY COMPARE FOOD 245 BEACH 20TH STREET FAR ROCKAWAY NY MEAT FARM 1035 ROUTE 9 FARMINGDALE NY BJ'S 50 DANIEL STREET FARMINGDALE NY STOP & SHOP 2350 NORTH OCEAN AVENUE FARMINGVILLE NY PENN TRAFFIC 5351 N. BURDICK STREET FAYETTEVILLE NY KEY FOOD 151 COVERT AVE FLORAL PARK NY MET FOOD JERICHO TURNPIKE FLORAL PARK NY QUICK CHEK 176 NORTH MAIN STREET FLORIDA NY KISSENA BEVERAGE RD AVENUE FLUSHING NY KING KULLEN 206 NEW HYDE PARK ROAD FRANKLIN SQUARE NY STOP & SHOP 245 EAST SUNRISE HIGHWAY FREEPORT NY BJ'S 100 MILL ROAD FREEPORT NY KEY FOOD TH AVENUE FRESH MEADOWS NY QUALITY MARKETS 20 CENTER STREET FREWSBURG NY SHOPRITE 56 RAMAPO ROAD GARNERVILLE NY PENN TRAFFIC 389 EAST MAIN STREET GOUVERNEUR NY ASSOCIATED 181 MIDDLE NECK ROAD GREAT NECK NY IGA 101 SOUTH STREET GREENPORT NY KING KULLEN 21 PONQUOGUE AVENUE HAMPTON BAYS NY STOP & SHOP 190 & 196 MONTAUK HIGHWAY HAMPTON BAYS NY TRADER JOE'S 215 NORTH CENTRAL PARK AVENUE HARTSDALE NY MEAT FARM 575 NESCONSET HIGHWAY HAUPPAUGE NY KING KULLEN 1765 PENINSULA BLVD. HEWLETT NY TRADER JOE'S 1280 WEST BROADWAY HEWLETT NY KING KULLEN 275 SOUTH BROADWAY HICKSVILLE NY STOP & SHOP 530 WEST OLD COUNTY ROAD HICKSVILLE NY STOP & SHOP SUNRISE HIGHWAY HOLBROOK NY STOP & SHOP 1328 BEEKMAN ROAD & ROUTE 55 HOPEWELL JUNCTION NY PENN TRAFFIC 18 PARK DRIVE HORNELL NY KING KULLEN 50 NEW YORK AVENUE HUNTINGTON NY STOP & SHOP 1100 JERICHO TURNPIKE HUNTINGTON NY STOP & SHOP U.S. ROUTE 9 & ST. ANDREWS HYDE PARK NY STOP & SHOP 603 BURNSIDE AVENUE INWOOD NY STOP & SHOP 1730 VETERAN'S MEMORIAL HIGHWAY ISLANDIA NY PENN TRAFFIC 315 PINE TREE ROAD ITHACA NY PENN TRAFFIC HANCOCK STREET ITHACA NY PENN TRAFFIC NORTH TRIPHAMMER ROAD ITHACA NY C-TOWN HILLSIDE AVENUE JAMAICA NY C-TOWN FOCH BOULEVARD JAMAICA NY KEY FOOD HILLSIDE AVENUE JAMAICA NY

5 QUALITY MARKETS 738 FOOTE AVENUE JAMESTOWN NY PECK'S MARKET 4897 STATE STREET JEFFERSONVILLE NY WHOLE FOODS-NY 429 NORTH BROADWAY JERICHO NY QUICK CHEK 630 WASHINGTON AVENUE KINGSTON NY QUICK CHEK 531 ALBANY AVENUE KINGSTON NY TRADER JOE'S 137 ALEXANDER AVENUE LAKE GROVE NY QUICK CHEK 1646 ROUTE 9 W LAKE KATRINE NY QUALITY MARKETS 279 EAST FAIRMOUNT AVENUE LAKEWOOD NY TRADER JOE'S 1260 BOSTON POST ROAD LARCHMONT NY BRACH'S 11 LAWRENCE LANE LAWRENCE NY KING KULLEN 3266 HEMPSTEAD TURNPIKE LEVITTOWN NY BJ'S 3635 HEMPSTEAD ROAD LEVITTOWN NY KING KULLEN 600 NORTH WELLWOOD AVENUE LINDENHURST NY KING KULLEN 455 PARK AVENUE LINDENHURST NY PECK'S MARKET 29 MAIN STREET LIVINGSTON MANOR NY QUALITY MARKETS 7134 ROCHESTER ROAD LOCKPORT NY MONARCH BEER 505 LONG BEACH BLVD. LONG BEACH NY STOP & SHOP TH STREET LONG ISLAND CITY NY PENN TRAFFIC ROUTES 12D & 26 LOWVILLE NY VILLAGE MARKET 344 HEMPSTEAD AVENUE MALVERNE NY WHOLE FOODS-NY 2101 NORTHERN BLVD. MANHASSET NY KING KULLEN 1430 NORTHERN BOULEVARD MANHASSET NY PENN TRAFFIC 119 WEST SENECA STREET MANLIUS NY KING KULLEN 460 COUNTRY ROAD #111 MANORVILLE NY STOP & SHOP GRAND AVENUE MASPETH NY KING KULLEN 4938 MERRICK ROAD MASSAPEQUA PARK NY VILLAGE FARM 1038 PARK BOULEVARD MASSAPEQUA PARK NY PENN TRAFFIC 152 HARTE HAVEN PLAZA MASSENA NY QUALITY MARKETS 64 SOUTH ERIE STREET MAYVILLE NY MEAT FARMS 1610 ROUTE 112 MEDFORD NY STOP & SHOP PATCHOGUE YAPHANK RD MEDFORD NY MERRICK MARKET 373 MERRICK AVENUE MERRICK NY STOP & SHOP 2160 SOUTH MERRICK MALL MERRICK NY TRADER JOE'S 1714 MERRICK ROAD MERRICK NY KING KULLEN 1235 MIDDLE COUNTRY ROAD MIDDLE ISLAND NY QUICK CHEK 9 COUNTY HIGHWAY # 108 MIDDLETOWN NY QUICK CHEK 751 ROUTE 211 E MIDDLETOWN NY KING KULLEN 52 JERICHO TURNPIKE MINEOLA NY STOP & SHOP 475 ROUTE 17 M MONROE NY BJ'S 232 LARKIN DRIVE MONROE NY IGA 1043 MONTAUK HIGHWAY MONTAUK NY KING KULLEN NESCONSET HIGHWAY MOUNT SINAI NY CARIBBEAN MARKET 333 SOUTH FULTON STREET MOUNT VERNON NY STOP & SHOP 300 SANFORD BOULEVARD MOUNT VERNON NY STOP & SHOP 32 SOUTH MIDDLETOWN ROAD NANUET NY PECK'S MARKET 120 KIRK ROAD NARROWSBURG NY SHOPRITE 66 NORTH MAIN STREET NEW CITY NY STOP & SHOP 653 HILLSIDE AVENUE NEW HYDE PARK NY NEW LEBANON ROUTE 20, VALLEY PLAZA NEW LEBANON NY STOP & SHOP 271 MAIN ST NEW PALTZ NY MET FOOD 430 PELHAM RD NEW ROCHELLE NY STOP & SHOP 28 HARRISON STREET NEW ROCHELLE NY STOP & SHOP 2425 PALMER AVENUE NEW ROCHELLE NY QUICK CHEK 170 WINDSOR HIGHWAY NEW WINDSOR NY ASSOCIATED 77 FULTON STREET NEW YORK NY ASSOCIATED 448 LENOX AVENUE NEW YORK NY CHELSEA PIERS CHELSEA PIERS, PIER # 62 NEW YORK NY WHOLE FOODS-NY 250-7TH AVENUE NEW YORK NY WHOLE FOODS-NY 4 UNION SQUARE NEW YORK NY WHOLE FOODS-NY BOWERY AND HOUSTON NEW YORK NY FAIRWAY MARKET TH AVENUE NEW YORK NY GRISTEDE'S 262 WEST 96TH STREET & BROADWAY NEW YORK NY GRISTEDE'S 907 8TH AVENUE & 54TH STREET NEW YORK NY GRISTEDE'S 315 SOUTH END AVENUE & BATTERY PIKE NEW YORK NY GRISTEDE'S 350 EAST 86TH STREET & 1ST AVENUE NEW YORK NY GRISTEDE'S 1644 YORK AVENUE & 87TH STREET NEW YORK NY GRISTEDE'S 251 WEST 86TH STREET & BROADWAY NEW YORK NY

6 GRISTEDE'S 1446 SECOND AVENUE & 75TH STREET NEW YORK NY GRISTEDE'S 71 SOUTH END AVENUE & BATTERY PIKE NEW YORK NY GRISTEDE'S 25 UNIVERSITY PLACE, 8TH STREET NEW YORK NY GRISTEDE'S 205 EAST 96TH STREET & 3RD AVENUE NEW YORK NY GRISTEDE'S 460 THIRD AVENUE & 32ND STREET NEW YORK NY GRISTEDE'S 1365 THIRD AVENUE & 78TH STREET NEW YORK NY GRISTEDE'S SECOND AVENUE & 29TH STREET NEW YORK NY GRISTEDE'S 1348 LEXINGTON AVENUE & 89TH ST. NEW YORK NY GRISTEDE'S 4037 BROADWAY & 170TH STREET NEW YORK NY GRISTEDE'S EAST END AVENUE & 81ST ST. NEW YORK NY GRISTEDE'S 246 MERCER STREET & WEST 4TH ST. NEW YORK NY GRISTEDE'S 504 COLUMBUS AVENUE & 84TH STREET NEW YORK NY GRISTEDE'S 1208 FIRST AVENUE & 65TH STREET NEW YORK NY GRISTEDE'S 686 NORTH MAIN STREET NEW YORK NY GRISTEDE'S 358 FIRST AVENUE & 20TH STREET NEW YORK NY GRISTEDE'S 25 WATERSIDE PLAZA & FDR DRIVE NEW YORK NY GRISTEDE'S 748 SECOND AVENUE & 40TH STREET NEW YORK NY GRISTEDE'S 3 SHERIDAN SQUARE & WEST 4TH NEW YORK NY GRISTEDE'S 225 NINTH AVENUE & 24TH STREET NEW YORK NY GRISTEDE'S 80 WEST END AVENUE & 64TH STREET NEW YORK NY GRISTEDE'S 307 WEST 26TH STREET & 8TH AVE NEW YORK NY GRISTEDE'S TH AVENUE & 22ND AVENUE NEW YORK NY GRISTEDE'S 2704 BROADWAY & 103RD STREET NEW YORK NY NEWBURGH OASIS 128 SOUTH ROBINSON AVENUE NEWBURGH NY STOP & SHOP ROUTE 87 AND MEADOW HILL ROAD NEWBURGH NY KING KULLEN 1170 DEER PARK AVENUE NORTH BABYLON NY NORTH BAY FOOD MART 2088 STATE RTE 49 NORTH BAY NY IGA FORT SALONGA ROAD NORTHPORT NY KING KULLEN 395 FT. SALONGA ROAD NORTHPORT NY STOP & SHOP 454 FORT SALONGA ROAD NORTHPORT NY PENN TRAFFIC 54 EAST MAIN STREET NORWICH NY KEY FOOD SPRINGFIELD BOULEVARD OAKLAND GARDENS NY STOP & SHOP 3577 LONG BEACH ROAD OCEANSIDE NY TRADER JOE'S 3418 LONG BEACH ROAD OCEANSIDE NY PENN TRAFFIC SEAWAY SHOPPING CENTER OGDENSBURG NY FALLS VILLAGE MARKET 187 NORTH MAIN STREET ORISKANY FALLS NY STOP & SHOP 246 SOUTH HIGHLAND AVENUE OSSINING NY PENN TRAFFIC 1145 ROUTE 17 C OWEGO NY STOP & SHOP 275 PINE HOLLOW ROAD OYSTER BAY NY ASSOCIATED TH STREET OZONE PARK NY C-TOWN CROSS BAY BOULEVARD OZONE PARK NY KEY FOOD LIBERTY AVENUE OZONE PARK NY KING KULLEN SUNRISE HIGHWAY PATCHOGUE NY SHOPRITE 26 NORTH MIDDLETOWN ROAD PEARL RIVER NY STOP & SHOP 1831 EAST MAIN STREET PEEKSKILL NY BJ'S 825 PELHAM PARKWAY PELHAM NY PENN TRAFFIC 321 LIBERTY STREET PENN YAN NY SHOPRITE 1054 OLD COUNTRY ROAD PLAINVIEW NY FAIRWAY MARKET 50 MANETTO ROAD PLAINVIEW NY SHOPRITE 144 WOODBURY RD PLAINVIEW NY TRADER JOE'S 425 SOUTH OYSTER BAY ROAD PLAINVIEW NY STOP & SHOP 1581 US HIGHWAY 202 POMONA NY STOP & SHOP 25 WATERFRONT STREET PORT CHESTER NY MEAT FARM 1067 ROUTE 112 PORT JEFFERSON STATION NY KING KULLEN 3 SHORE ROAD PORT WASHINGTON NY STOP & SHOP 65 SHORE ROAD PORT WASHINGTON NY PENN TRAFFIC 201 MARKET STREET POTSDAM NY FOODTOWN (PSK) FREEDOM PLACE ROAD, ROUTE 55 POUGHKEEPSIE NY STOP & SHOP 2540 SOUTH ROAD POUGHKEEPSIE NY PENN TRAFFIC 3830 ROME ROAD PULASKI NY KEY FOOD JAMAICA AVENUE QUEENS VILLAGE NY PRICE RITE 749 UPPER GLENN STREET QUEENSBURY NY MET FOOD RD STREET REGO PARK NY TRADER JOE'S METROPOLITAN AVENUE REGO PARK NY STOP & SHOP MYRTLE AVENUE RIDGEWOOD NY STOP & SHOP 8989 UNION TURNPIKE RIDGEWOOD NY KING KULLEN 795 OLD COUNTRY ROAD RIVERHEAD NY

7 STOP & SHOP 1615 OLD COUNTRY ROAD RIVERHEAD NY BJ'S 607 OLD COUNTRY ROAD RIVERHEAD NY PRICE RITE 375 DRIVING PARK AVENUE ROCHESTER NY PRICE RITE 1230 UNIVERSITY & CULVER DRIVE ROCHESTER NY PRICE RITE 3333 WEST HENRIETTA ROAD ROCHESTER NY BJ'S 400 JAY SCUTTI BOULEVARD ROCHESTER NY BJ'S 300 BELLWOOD DRIVE ROCHESTER NY PENN TRAFFIC 217 ERIE BOULEVARD WEST ROME NY MEAT FARMS 318 PORTION ROAD RONKONKOMA NY KING KULLEN 153 RONKONKOMA AVENUE RONKONKOMA NY LAKE RONKONKOMA 316 SMITHTOWN BOULEVARD RONKONKOMA NY STOP & SHOP 449 PORTION ROAD RONKONKOMA NY KING KULLEN 472 LAKE AVENUE SAINT JAMES NY SANBORN MARKET PLACE 2956 SAUNDERS SETTLEMENT ROAD SANBORN NY BJ'S 3067 RTE 50 SARATOGA SPRINGS NY QUICK CHEK 2820 ROUTE 32 SAUGERTIES NY STOP & SHOP 191 MONTAUK HIGHWAY SAYVILLE NY GRISTEDE'S 1100 WILLMOT AVENUE SCARSDALE NY TRADER JOE'S 727 WHITE PLAINS ROAD SCARSDALE NY PRICE RITE 2330 WATT STREET SCHENECTADY NY KING KULLEN BOYLE ROAD & ROUTE 25 SELDEN NY SHELTER ISLAND IGA 75 NORTH FERRY ROAD SHELTER ISLAND NY PENN TRAFFIC 87 EAST STATE STREET SHERRILL NY KING KULLEN 273 WILLIAM FLOYD PARKWAY SHIRLEY NY STOP & SHOP 999 MONTAUK HIGHWAY SHIRLEY NY QUALITY MARKETS 140 CENTRAL AVENUE SILVER CREEK NY PENN TRAFFIC 40 FENNEL STREET SKANEATELES NY STOP & SHOP 291 WEST MAIN STREET SMITHTOWN NY FARM BOY ROCKAWAY BOULEVARD SOUTH OZONE PARK NY PIONEER TH AVENUE SOUTH OZONE PARK NY ASSOCIATED ST AVENUE SOUTH RICHMOND HILL NY KEY FOOD ST AVENUE SOUTH RICHMOND HILL NY IGA MAIN STREET SOUTHOLD NY FOODMART INTL 175 RTE 159 SPRING VALLEY NY KING KULLEN 244 ARDEN AVENUE STATEN ISLAND NY STOP & SHOP 2795 RICHMOND AVENUE STATEN ISLAND NY STOP & SHOP 2754 HYLAN BOULEVARD STATEN ISLAND NY EMMANUELS 3853 ROUTE 209 STONE RIDGE NY SHOPRITE 250 ROUTE 59 SUFFERN NY PENN TRAFFIC 181 SHOP CITY SYRACUSE NY PENN TRAFFIC 620 NOTTINGHAM ROAD SYRACUSE NY PENN TRAFFIC 4410 EAST GENESEE STREET SYRACUSE NY PENN TRAFFIC 2120 WEST GENESEE STREET SYRACUSE NY PENN TRAFFIC 3803 BREWERTON ROAD SYRACUSE NY BJ'S 400 RIVER ROAD UTICA NY KING KULLEN 231 WEST MERRICK ROAD VALLEY STREAM NY BJ'S 125 GREEN ACRES ROAD VALLEY STREAM NY BJ'S 50 E-VIEW MALL DRIVE VICTOR NY KING KULLEN 6233 ROUTE 25 A WADING RIVER NY KING KULLEN 1340 WANTAGH AVENUE WANTAGH NY STOP & SHOP 1357 ROUTE 9 WAPPINGERS FALLS NY BJ'S RTE 9 AT MYERS CORNER ROAD WAPPINGERS FALLS NY PENN TRAFFIC 1963 KINGDOM PLACE WATERLOO NY PENN TRAFFIC SEAWAY SHOPPING CENTER WATERTOWN NY FOOD KING 139 MAIN STREET WATERVILLE NY PENN TRAFFIC SOUTH FRANKLIN STREET WATKINS GLEN NY BJ'S 950 RIDGE ROAD WEBSTER NY STOP & SHOP 88 GOLDING AVENUE WEST BABYLON NY STOP & SHOP 575 MONTAUK HIGHWAY WEST BABYLON NY STOP & SHOP 7 SAMSONDALE PLAZA, ROUTE 9 W WEST HAVERSTRAW NY STOP & SHOP 420 HEMPSTEAD TURNPIKE WEST HEMPSTEAD NY HURLEY RIDGE ROUTE 375 WEST HURLEY NY KING KULLEN 480 UNION BOULEVARD WEST ISLIP NY STOP & SHOP 400 UNION BLVD WEST ISLIP NY SHOPRITE 243 E.ROUTE 59 WEST NYACK NY BJ'S PALISADES CENTER WEST NYACK NY C-TOWN 306 POST AVENUE WESTBURY NY

8 BJ'S BRUSH HOLLOW DRIVE WESTBURY NY QUALITY MARKETS 121 EAST MAIN STREET WESTFIELD NY STOP & SHOP 670 NORTH BROADWAY WHITE PLAINS NY KISSENA FARMS KISSENA BOULEVARD WHITESTONE NY C-TOWN JAMAICA AVENUE WOODHAVEN NY COMPARE FOODS JAMAICA BOULEVARD WOODHAVEN NY W G-MART 2930 STATE ROAD 209 WURTSBORO NY LAKE AVENUE 129 LAKE AVENUE YONKERS NY BJ'S 3303 CROMPOND AVENUE YORKTOWN HEIGHTS NY

9 I - - *Date: *Name: _La _ s _ t check IF NEW address:o *Address: *City: State: OR *Zip: *Phone: Voic Em a i I: , ,...---,--...,,...-,-...,...,...,..-,---- Mail us your empty Perfect Empowered Drinking Water 1M Bottles along with this form We suggest you use your empty Perfect Water Box, but any box will be fine. (Please Note: We will accept ONLY Perfect Empowered Drinking Water "' Botrles for recycling) Once received, Perfect Water & Essentials LLC will mall you a check reimbursing both your paid deposit on the bottles and shippin costs. *Bottle Count: Number of bottles being returned: X $0.10 ='._.$ a,.._,,, *Shipping Costs: Cost of shipping the empty bottles to us: =I..._$ _;....I Total Reimbursement: = lw$.i *re uired fields must be filled out for reimbursement BE SURE TO INCLUDE THIS FORM IN THE BOX WHEN MAILING THE BOTTLES BACK TO US :MAIL TO: :MAIL TO:, :MAIL TO:,l,, :MAIL TO:,.e. :MAIL TO: From: Perfect Water & Essentials LLC Attn: PWB Recycle Department 2484 West Custer Road Salt Lake City, UT 84104