Quantifying suspended sediment loads is important for managing the world's estuaries in the context of navigation, pollutant transport, wetland restoration, and coastal erosion. To address these needs, a comprehensive analysis was completed on sediment supply to San Francisco Bay from fluvial sources. Suspended sediment, optical backscatter, velocity data near the head of the estuary, and discharge data obtained from the output of a water balance model were used to generate continuous suspended sediment concentration records and compute loads to the Bay from the large Central Valley watershed. Sediment loads from small tributary watersheds around the Bay were determined using 235 station-years of suspended sediment data from 38 watershed locations, regression analysis, and simple modeling. Over 16 years, net annual suspended sediment load to the head of the estuary from its 154,000 km2 Central Valley watershed varied from 0.13 to 2.58 (mean = 0.89) million metric t of suspended sediment, or an average yield of 11 metric t/km2/yr. Small tributaries, totaling 8145 km2, in the nine-county Bay Area discharged between 0.081 and 4.27 (mean = 1.39) million metric t with a mean yield of 212 metric t/km2/yr. The results indicate that the hundreds of urbanized and tectonically active tributaries adjacent to the Bay, which together account for just 5% of the total watershed area draining to the Bay and provide just 7% of the annual average fluvial flow, supply 61% of the suspended sediment. The small tributary loads are more variable (53-fold between years compared to 21-fold for the inland Central Valley rivers) and dominated fluvial sediment supply to the Bay during 10 out of 16 yr. If San Francisco Bay is typical of other estuaries in active tectonic or climatically variable coastal regimes, managers responsible for water quality, dredging and reusing sediment accumulating in shipping channels, or restoring wetlands in the world's estuaries may need to more carefully account for proximal small urbanized watersheds that may dominate sediment supply.