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4. Sample of each nominal 20,000 11111 pound shipment furnished ( ) Sent Under Seperate Cover <br /> 5. Weight ticket(s)for each nominal ( ) Sent Under Seperate Cover • <br /> 20,000 pound load furnished <br /> CONTRACTORS CERTIFICATION: <br /> The undersigned CONTRACTOR certifies that(1) all previous progress payments received <br /> from OWNER on account of work done under the Contract referred to above have been applied to <br /> discharge in full all obligations of CONTRACTOR incurred in connection with Work covered by <br /> prior Applications for Payment; and (2)title to all materials and equipment incorporated in said <br /> Work or otherwise listed in or covered by this Application for Payment will pass to OWNER at <br /> time of payment free and clear of all liens, claims, security interests, and encumbrances (except <br /> such as covered by Bond acceptable to OWNER). <br /> Dated: May 12, 1997 Calgon Carbon Corporation <br /> (Contractor) <br /> By <br /> John M. MacCrum <br /> Title: Senior Vice President <br /> Payment of the above AMOUNT DUE CONTRACTOR THIS APPLICATION is recommended. <br /> • Dated: S f fl 617 Barr Eng <br /> ineering Co. <br /> (Owner's Represent <br /> By: <br /> • 2362210\19437-7/LAH <br />